{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T13:41:13Z","timestamp":1793108473451,"version":"4.5.0"},"reference-count":35,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T00:00:00Z","timestamp":1750377600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Cancers"],"abstract":"<jats:p>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\u2014distinct 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.<\/jats:p>","DOI":"10.3390\/cancers17132063","type":"journal-article","created":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T06:50:45Z","timestamp":1750402245000},"page":"2063","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Management of Triple M Syndrome: A Systematic Review with Narrative Synthesis of Immune Checkpoint Inhibitor-Induced Myasthenia Gravis, Myositis and Myocarditis"],"prefix":"10.3390","volume":"17","author":[{"given":"Martin","family":"Furlepa","sequence":"first","affiliation":[{"name":"Department of Neurology, University College Hospital, London NW1 2BU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella","family":"Watts","sequence":"additional","affiliation":[{"name":"Department of Oncology, Imperial College Healthcare NHS Trust, London W6 8RF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aisling","family":"Carr","sequence":"additional","affiliation":[{"name":"Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, UCLH, London WC1N 3BG, UK"},{"name":"Department of Neuromuscular Diseases, Institute of Neurology UCL, London WC1N 3BG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,20]]},"reference":[{"key":"ref_1","first-page":"5126717","article-title":"The Terrible Triad of Checkpoint Inhibition: A Case Report of Myasthenia Gravis, Myocarditis, and Myositis Induced by Cemiplimab in a Patient with Metastatic Cutaneous Squamous Cell Carcinoma","volume":"2020","author":"Jeyakumar","year":"2020","journal-title":"Case Rep. 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