Gene-Editing Technologies in Adoptive T Cell Therapy for Cancer: An Ethical Analysis

Abstract Background In recent years, a new and very promising form of immunotherapy has emerged, i.e., adoptive T cell therapy. The current standard treatment requires autologous adoptive cell transfer, which is rather expansive and time-consuming. To generate universal and more potent modified T cells, gene-editing technologies (such as ZFNs, TALENs and CRISPR–Cas9 system) have recently been applied. Aim To discuss the application of gene-editing technologies to adoptive T cell immunotherapy for cancer from an ethical standpoint. Materials and method A comprehensive literature search was conducted using the PubMed-NCBI database. The analysis was carried out in the light of the four well-known moral principles of beneficence/nonmaleficence, autonomy and justice. Findings (1) the benefit–risk ratio of applications of gene-editing technologies to adoptive T cell immunotherapy is complex to evaluate and remains still uncertain; (2) these applications are subject to current informed consent procedures on medical experimentations and interventions, even though informed consent processes can be supported by specific documents; (3) these applications will probably raise issues in terms of justice, even though no specific consideration can be currently drawn. Conclusions: The combination of chimeric antigen receptor–T cell technology with gene-editing technologies seems to have inaugurated a new and promising era in cancer immunotherapy. To arrive at better-founded ethical evaluation of this combination, further studies are requested.