Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are an effective treatment for common EGFR mutations in non-small-cell lung cancer (NSCLC). Rarer EGFR mutations such as kinase domain duplications (KDDs) have been identified, but the optimal therapy following treatment resistance remains unknown. We report two patients who were diagnosed with NSCLC including KDD. For case 1, afatinib (40 mg once daily) was at first effective but then became ineffective. Consequently, osimertinib therapy (80 mg once daily) was administered. As of 26 May 2021, the osimertinib therapy achieved a stable disease state according to the chest computed tomography scan. As for case 2, the patient received second-line chemotherapy and anlotinib (12 mg once daily) for 6 months and died in May 2020. Here, we describe osimertinib as an effective therapy for EGFR-KDD positive lung adenocarcinoma and thereby provide a new alternative for further treatment following resistance to first-and second-generation EGFR-TKIs.

Objective: Studies examining the effects of tirofiban combined with other conventional drugs for treating patients with acute coronary syndrome (ACS) are lacking. Thus, in this study, we conducted a meta-analysis investigating both the safety and efficacy of intracoronary (IC) administration of tirofiban treatment alone versus in combination with other conventional treatments for the no-reflow phenomenon (NRP) during percutaneous coronary intervention (PCI) in patients with ACS. Methods: PubMed, Cochrane Library, Embase, Chinese Biomedical (CBM), Google Scholar, and China National Knowledge Infrastructure (CNKI) databases were searched for randomized controlled trials (RCTs) that included data comparing tirofiban treatment alone versus in combination with other conventional therapies. Two independent reviewers evaluated the quality of all data and studies were evaluated according to the Cochrane Collaboration Handbook 5.3. Results: Thirteen RCTs involving 937 patients were included in our analysis. Tirofiban plus conventional drug treatment improved thrombolysis in myocardial infarction (TIMI) grade 3 flow (OR: 0.18; 95% CI: 0.11–0.30; p<0.01), corrected TIMI frame count (CTFC) (WMD: 6.61; 95% CI: 4.69–8.53; p<0.01), and corrected left ventricular ejection fraction (LVEF) (WMD: −3.76; 95% CI: −4.70 to −2.82; p<0.01) and reduced major adverse cardiovascular events (MACE) (OR: 3.9; 95% CI; 2.51–6.07; p<0.01). Tirofiban plus conventional therapy reduced bleeding; however, no statistical significance was observed (OR: CI: 0.50–3.12; p=0.64). Conclusion: IC administration of tirofiban combined with conventional drugs is more effective than tirofiban treatment alone for no-reflow (NR) during PCI without increasing bleeding events. This combination is recommended as an optimal strategy for preventing NR.