With the maturity of the service outsourcing market and the development of business relations, the core of outsourcing is shifting from transactional services to risk sharing and value creation. The client and service provider have an increasing interest in service innovation. Although cooperative innovation between them has many benefits, the two parties do not necessarily establish a cooperative innovation relationship. Regarding this issue, an evolutionary game focusing on client-service provider cooperative innovation behavior is constructed and solved. Based on the results and a corresponding numerical simulation, the decision-making mechanism of the cooperative innovation behavior is studied, and suggestions are provided regarding how to promote cooperative innovation. The results show that the benefits of both the client and service provider when they innovate cooperatively being greater than that when they innovate independently cannot guarantee that the system will certainly evolve to a stable state in which both parties adopt a cooperation strategy. However, as long as a condition in which either party gains more than zero when it innovates independently is established in addition to the preceding condition, the system will certainly evolve to a stable state in which both parties adopt a cooperative strategy. The following measures can be taken to promote client-service provider cooperation: improving the initial probabilities of the two parties choosing the cooperative strategy; increasing the innovation benefit when one party innovates independently; reducing the innovation cost and spillover coefficient when one party innovates independently; increasing the penalty when one party cooperates and the other party does not; decreasing the innovation cost when the two parties both choose the cooperation strategy; increasing the excess benefit when the two parties both cooperate; setting reasonable benefit distribution and cost sharing proportions.

Introduction: RET-rearranged fusions have been considered as oncogenic drivers in 1% to 2% of non-small cell lung cancers (NSCLC). ARROW study has demonstrated a new selective RET tyrosine kinase inhibitors (TKIs) shows remarkable and durable responses in RET-rearranged NCSLC. In this study mainly recruited patients with common fusion partners KIF5B and CCDC6. There is still a lack of definitive conclusions about effective of rare RET fusion variants to anti-RET therapies.Case report: A Chinese 58-year-old female renal insufficient patient with no history of smoking was diagnosed as stage IIIA (T2N2M0) lung adenocarcinoma. Next-generation sequencing targeting 520 cancer-related genes was performed on the pleural effusion samples and revealed 2 novel RET fusions LINCO1264-RET and SEMA5A-RET, concomitant with a common CCDC6-RET. Management and outcome:The patient was first treated with multiple lines of chemotherapy and switched to lenvatinib but failed to respond. Due to renal insufficiency, she subsequently received pralsetinib with gradually reduced dosages (400 mg-300 mg-200 mg-100 mg qd) and achieved a partial response (PR) lasting for more than 10 months, accompanied by the declined allele frequencies of all 3 RET fusions.Discussion/conclusions: We reported the first case of the pralsetinib efficacy in NSCLC with 3 concurrent RET fusions. Our case also indicates the sensitivity of the newly identified RET fusions to this RET selective inhibitor pralsetinib, and highlights the low-dose treatment option for patients with renal insufficient background.Abbreviations: NSCLC = non-small cell lung cancer, PR = partial response, TKIs = tyrosine kinase inhibitors.