Background:The advent of immunotherapy has revolutionised cancer treatment by harnessing the immune system to target tumour cells. However, there is increasing awareness of immunotherapy-related adverse events, which can be severe and even fatal. While system-specific immune-related adverse events (ir-AEs) are well documented, growing evidence suggests the existence of overlap syndromes—distinct clusters of immune-mediated complications. One such syndrome is the overlap of myasthenia gravis, myositis and myocarditis, collectively known as Triple M (3M) syndrome. This syndrome is complex, varying in presentation and severity, with in-hospital mortality rates approaching 40%. Whilst there is consensus on the management of system-specific complications, there is no consensus guidance for the management of these overlap syndromes.Methods:In this paper, we conduct a review of the literature, analysing reported cases of 3M syndrome, focusing on treatment approaches and patient outcomes at an individual level.Conclusions:This review highlights the complexity of diagnosing and managing 3M syndrome due to inconsistent reporting, lack of standardised criteria for diagnosis, and treatment variability. While evidence remains limited, we offer broad clinical recommendations and underscore the urgent need for consensus definitions, prospective data collection, and structured treatment guidance.
背景：免疫疗法的出现通过利用免疫系统靶向肿瘤细胞，彻底改变了癌症治疗。然而，人们日益认识到免疫治疗相关不良事件可能严重甚至致命。虽然系统特异性免疫相关不良事件已有充分记录，但越来越多的证据表明存在重叠综合征——即独特的免疫介导并发症群。其中一种综合征是重症肌无力、肌炎和心肌炎的重叠，统称为三重M（3M）综合征。该综合征表现复杂，严重程度不一，院内死亡率接近40%。尽管对系统特异性并发症的管理已有共识，但对于这些重叠综合征的管理尚无统一的指导原则。 方法：本文通过文献综述，分析已报道的3M综合征病例，重点关注个体层面的治疗方法和患者结局。 结论：本综述指出，由于报告不一致、缺乏标准化诊断标准以及治疗方案的多样性，3M综合征的诊断和管理具有高度复杂性。尽管现有证据有限，我们仍提出广泛的临床建议，并强调亟需建立共识定义、开展前瞻性数据收集和制定结构化治疗指南。
肿瘤(癌症)患者之家