tinyE: It has to be a joke.
Would you want to play a serious game about someone that runs around on a killing spree? :P
If games like this don't come with tongue planter firmly in cheek then all they are is stark reminder of what is really out there. Who wants to play that?
What's really out where? Mass murder is ultra-rare per capita. Murder is already pretty rare and mass murder is much much rarer - especially one that isn't gang related or isn't just perpetrator killing himself and his family.
Also, I think that treating the subject as a joke is much more "problematic" than making a serious, realistic game about the subject. War is arguably a much worse subject and people have no problems playing/making serious war games.
tinyE: Ditto for Carmageddon. It works because it is a joke.
I think ultra-serious grimdark Carmageddon would work quite well.