This
document
is
a
summary
of
the
European
Public
Assessment
Report
(
EPAR
)
.
It
explains
how
the
Committee
for
Medicinal
Products
for
Human
Use
(
CHMP
)
assessed
the
studies
performed
,
to
reach
their
recommendations
on
how
to
use
the
medicine
.
If
you
need
more
information
about
your
medical
condition
or
your
treatment
,
read
the
Package
Leaflet
(
also
part
of
the
EPAR
)
or
contact
your
doctor
or
pharmacist
.
If
you
want
more
information
on
the
basis
of
the
CHMP
recommendations
,
read
the
Scientific
Discussion
(
also
part
of
the
EPAR
)
.
What
is
Alimta
?
Alimta
is
a
powder
that
is
made up
into
a
solution
for
infusion
(
drip
into
a
vein
)
.
It
contains
the
active
substance
pemetrexed
.
What
is
Alimta
used
for
?
Alimta
is
used
to
treat
two
types
of
cancer
:
pleural
mesothelioma
(
cancer
of
the
lining
of
the
lungs
that
is
usually
caused
by
exposure
to
asbestos
)
.
Alimta
is
used
together with
cisplatin
(
another
anticancer
medicine
)
when
the
cancer
is
unresectable
(
cannot
be
removed
by
surgery
alone
)
and
malignant
(
has
spread
,
or
is
likely
to
spread
easily
,
to
other
parts
of
the
body
)
,
in
patients
who
have
not
received
chemotherapy
(
medicines
for
cancer
)
before
advanced
or
metastatic
non-small
cell
lung cancer
that
is
not
affecting
the
squamous cells
.
Alimta
is
used
in
combination
with
cisplatin
in
patients
who
have
not
been
treated
before
,
and
on
its
own
in
patients
who
have
received
another
type
of
chemotherapy
in
the
past
.
The
medicine
can
only
be
obtained
with
a
prescription
.
How
is
Alimta
used
?
Alimta
should
only
be
given
under
the
supervision
of
a
doctor
who
is
qualified
in
the
use
of
anticancer
chemotherapy
.
The
recommended
dose
of
Alimta
is
500
mg
per
square metre
of
body
surface area
(
calculated
using
the
patient
s
height
and
weight
)
.
It
is
given
once
every
three
weeks
as
an
intravenous
infusion
lasting
10
minutes
.
To
reduce
side effects
,
patients
should
take
a
corticosteroid
and
folic acid
(
a
type
of
vitamin
)
,
and
receive
injections
of
vitamin B12
during
treatment
with
Alimta
.
When
Alimta
is
given
with
cisplatin
,
an
anti-emetic
medicine
(
to
prevent
vomiting
)
and
fluids
(
to
prevent
dehydration
)
should
also
be
given
before
or
after
the
cisplatin
dose
.
Treatment
should
be
delayed
or
discontinued
,
or
the
dose
reduced
,
in
patients
whose
blood counts
are
abnormal
or
who
have
certain
other
side effects
.
Alimta
is
not
recommended
for
use
in
patients
with
moderate
or
severe
kidney
problems
.
For
more
information
,
see
the
Summary
of
Product
Characteristics
(
also
part
of
the
EPAR
)
.
How
does
Alimta
work
?
The
active
substance
in
Alimta
,
pemetrexed
,
is
a
cytotoxic
medicine
(
a
medicine
that
kills
cells
that
are
dividing
,
such
as
cancer cells
)
,
which
belongs to
the
group
antimetabolites
.
In
the
body
,
pemetrexed
is
converted
into
an
active
form
that
blocks
the
activity
of
the
enzymes
that
are
involved
in
producing
nucleotides
(
the
building blocks
of
DNA
and
RNA
,
the
genetic
material
of
cells
)
.
How
has
Alimta
been
studied
?
For
the
treatment
of
malignant
pleural
mesothelioma
,
Alimta
has
been
studied
in
one
main
study
in
456
patients
who
had
not
received
chemotherapy
for
their
disease
before
.
The
effects
of
Alimta
in
combination
with
cisplatin
were
compared
with
those
of
cisplatin
alone
.
For
the
treatment
of
non-small
cell
lung cancer
,
the
effects
of
Alimta
were
compared
with
those
of
docetaxel
(
another
anticancer
medicine
)
in
one
study
involving
571
patients
with
locally
advanced
or
metastatic
disease
who
had
received
chemotherapy
in
the
past
.
Alimta
was
also
compared
with
gemcitabine
(
another
anticancer
medicine
)
,
both
in
combination
with
cisplatin
,
in
a
study
involving
1,725
patients
who
had
not
received
chemotherapy
for
lung cancer
in
the
past
.
In
all
three
studies
,
the
main
measure
of
effectiveness
was
how
long
the
patients
survived
.
What
benefit
has
Alimta
shown
during
the
studies
?
Alimta
increased
the
survival
time
of
patients
with
malignant
pleural
mesothelioma
.
Patients
receiving
Alimta
and
cisplatin
survived
for
an
average
of
12.1
months
,
compared
with
9.3
months
in
those
receiving
cisplatin
alone
.
In
the
treatment
of
patients
with
non-small
cell
lung cancer
,
Alimta
was
as
effective
as
the
comparators
.
In
patients
who
had
received
chemotherapy
in
the
past
,
the
average
survival
time
was
8.3
months
with
Alimta
,
compared
with
7.9
months
with
docetaxel
.
In
patients
who
had
not
received
chemotherapy
in
the
past
,
the
average
survival
time
was
10.3
months
in
both
groups
.
However
,
in
both
studies
,
patients
whose
cancer
was
not
affecting
squamous cells
had
longer
survival
times
if
they
received
Alimta
than
if
they
received
the
comparator
.
In
contrast
,
patients
whose
cancer
was
affecting
squamous cells
had
shorter
survival
times
if
they
received
Alimta
.
kalgebra
is
a
mathematical
calculator
based
on
content
markup
MathML
language
.
Nowadays
it
is
capable
to
make
simple
MathML
operations
(
arithmetic
and
logical
)
and
to
representate
2D
and
3D
graphs
.
It
is
actually
not
necessary
to
know
MathML
to
use
kalgebra
.
kalgebra
is
a
MathML
based
graph
calculator
.
Although
it
was
initially
MathML
oriented
it
can
now
be
used
by
everyone
with
little
mathematical
knowledge
.
Here
's
a
screenshot
of
kalgebra
main
window
kalgebra
main
window
kalgebra
main
window
consists
in
a
Console
tab
,
a
2D
Graph
tab
,
a
3D
Graph
tab
and
a
Dictionary
tab
.
Below
these
tabs
you
will
find
an
input
field
to
type
your
functions
or
do
your
calculations
.
If
we
want
to
understand
how
it
works
,
the
best
thing
we
can
do
is
to
realize
that
our
input
is
being
converted
into
MathML
although
it
is
not
necessary
to
know
MathML
.
I
have
based
the
syntax
basically
on
common sense
,
it
should
not
be
hard
for
anyone
.
I
ve
looked
closely
to
maxima
and
maple
s
syntax
so
they
look
very
similar
.
+
-
*
/
:
Addition
,
subtraction
,
multiplication
and
division
.
^
,
**
:
Power
,
you
can
use
them
both
.
Also
it
is
possible
to
use
the
unicode
²
characters
.
Powers
are
one
way
to
make
roots
too
.
-gt
:
It
s
the
way
to
specify
the
bounded
variable
in
a
function
.
(
)
:
It
is
used
to
specify
a
higher
priority
.
abc(params)
:
When
the
parser
finds
a
function
,
it
checks
if
abc
is
an
operator
.
If
it
is
,
it
will
be
treated
as
an
operator
,
if
it
is
not
,
it
will
be
treated
as
a
user
function
.
:
=
:
It
is
used
to
define
a
variable
value
.
?
:
Piecewise
condition
definition
.
Piecewise
is
the
way
we
can
define
conditional
operations
in
kalgebra
.
If
we
introduce
the
condition
before
the
?
it
will
use
this
condition
only if
it
is
true
,
if
it
finds
a
?
without
any
condition
,
it
will
enter
in
the
last
instance
.
{
}
:
MathML
container
.
It
can
be
used
to
define
a
container
.
Mainly
useful
for
working
with
piecewise
.
Now
you
could
ask
me
,
why
should
the
user
mind
about
MathML
?
That
s
easy
.
With
this
,
we
can
operate
with
functions
like
cos()
,
sin()
,
any
other
trigonometric
functions
,
sum
()
or
product
()
.
It
does
not
matter
what
kind
it
is
.
We
can
use
plus()
,
times()
and
everything
which
has
its
operator
.
kalgebra
's
console
is
useful
as
a
calculator
.
There
you
have
a
list
of
the
declared
variables
.
By
double
clicking
on
them
you
will
see
a
dialog
that
lets
you
change
their
values
(
just
a
way
to
trick
the
log
)
.
Every
time
you
enter
an
expression
,
the
"
ans
"
variable
value
will
be
changed
to
the
last
result
.
Ctrl
N
New
Window
Flushes
the
log
.
Ctrl
L
Load
Script
Executes
the
instructions
in
a
file
sequentially
.
Nice
if
you
want
to
define
some
libraries
or
resume
some
previous
work
.
Ctrl
G
Save
Script
Saves
the
instructions
you
have
typed
since
the
session
began
to
be
able
to
reuse
.
Generates
text files
so
it
should
be
easy
to
fix
using
any
text editor
,
like
Kate
.
Ctrl
S
Save
Log
Saves
the
log
with
all
results
into
an
HTML
file
to
be
able
to
print
or
publish
.
Ctrl
Q
Quit
Shuts
the
program
down
.
To
add
a
new
2D
graph
on
kalgebra
,
what
you
have
to
do
is
to
go
to
the
2D
Graph
tab
and
click
in
the
Add
tab
to
add
the
new
function
.
Then
your
focus
will
go
to
an
input
text
box
where
you
can
type
your
function
.
If
you
want
to
use
a
typical
f(x)
function
it
is
not
necessary
to
specify
it
.
If
you
have
entered
the
function
click
on
the
OK
button
to
display
the
graph
in
the
main
window
.
You
can
set
several
graphs
on
the
same
view
.
Just
use
the
Add
button
when
you
are
in
List
mode
.
You
can
set
each
graph
its
own
color
.
The
Foundation
has
recently
been
involved
in
organising
a
conference
which
dealt
with
this
critical
challenge
.
Over
100
participants
from
the
main
interest groups
attended
and
debated
issues
such
as
the
role
of
key
actors
including
public
authorities
,
social
partners
,
voluntary
and
community
organisations
as well
as
service
users
.
There
were
relatively
few
cases
reported
of
attempts
to
involve
users
in
service
planning
but
their
involvement
in
service
provision
was
found
to
be
more
common
.
Note
was
also
taken
of
the
variety
of
different
roles
played
by
public
welfare
The
Foundation
organised
,
together
with
the
European
Commission
,
the
Spanish
Ministry
of
Social
Affairs
and
the
Galician
regional
government
,
a
European
conference
on
social
exclusion
:
a
major
challenge
for
public
welfare
services
.
The
Foundation
recently
published
a
comparative
study
as
part
of
the
EPOC
project
which
assesses
the
extent
to
which
direct
participation
can
humanise
work
while
increasing
profitability
.
The
study
is
based
on
195
personal
interviews
with
senior
officials
of
the
social
partners
as
representatives
of
national
level
peak
organisations
in
fifteen
European
countries
.
As
important
industrial
sectors
,
the
metal
industry
and
the
banking
sector
were
also
included
.
Key
speakers
at
the
social
exclusion
conference
were
(
left
to
right
)
Cristina
Louro
,
Employment
,
Industrial
Relations
and
Social Affairs
Directorate
,
European
Commission
Fernando
Gomes
,
a
high
degree
of
Committee
of
the
Regions
Barbara
Weiler
,
Member
of
the
European
Parliament
José
Maria
Gil-Robles
,
Vice-President
,
European
Parliament
and
John
Carroll
,
Economic
and
Social
Committee
.
Case Studies
Each
national
report
contains
a
portfolio
of
between
25
and
30
initiatives
which
best
present
policies
and
practices
to
improve
the
recruitment
,
training
and
development
of
ageing
workers
in
both
the
work
place
and
the
community
.
For
each
country
,
two
or
three
initiatives
have
been
selected
for
further
in
depth
case study
.
These
case studies
analysed
the
background
of
the
initiatives
,
their
impact
on
employment
patterns
and
work
organisations
and
assessed
the
benefits
and
problems
of
the
initiative
.
Visits
and
interviews
with
key
personnel
were
also
undertaken
.
These
national
studies
will
form
the
basis
of
a
European
report
which
synthesises
overall
practices
.
The
report
and
a
casebook
of
initiatives
will
be
published
in
1996
and
provide
the
backdrop
for
a
conference
to
be
staged
in
Autumn
,
1996
.
The
Foundation
aims
to
document
the
characteristics
of
age
barriers
in
job
recruitment
and
training
and
to
analyse
their
causes
.
The
perspectives
of
the
social
partners
is
also
being
examined
,
with
particular
attention
paid
to
proposals
for
removing
age
barriers
.
Thirdly
,
the
project
documents
and
assesses
initiatives
,
in
both
the
public
and
private
sectors
which
combat
age
barriers
,
especially
for
older
workers
.
Seeking
alternatives
to
early
retirement
and
redundancy
,
the
project
is
primarily
concerned
with
the
retention
,
reintegration
and
retraining
of
older
workers
.
The
gender
and
ethnic
backgrounds
of
workers
and
how
these
relate
to
age
discrimination
are
examined
.
The
project
also
considers
initiatives
to
combat
age
discrimination
in
rural areas
and
in
small
and
medium
sized
enterprises
.
Seven
member
states
are
covered
by
the
project
:
Belgium
,
France
,
Germany
,
Greece
,
Italy
,
the
Netherlands
and
the
United
Kingdom
.
This
document
is
a
summary
of
the
European
Public
Assessment
Report
.
It
explains
how
the
Committee
for
Medicinal
Products
for
Veterinary
Use
(
CVMP
)
assessed
the
studies
performed
,
to
reach
their
recommendations
on
how
to
use
the
medicine
.
What
is
Cerenia
?
Cerenia
contains
the
active
substance
maropitant
and
is
available
as
tablet
or
as
solution
for
injection
.
The
tablets
are
pale-orange
and
have
a
score
line
on
both
sides
so
that
they
can
be
halved
.
Each
tablet
is
marked
with
the
Pfizer
logo
on
one
side
and
with
the
letters
MPT
and
the
quantity
of
maropitant
on
the
other
side
.
What
is
Cerenia
used
for
?
Cerenia
is
an
anti-emetic
,
this
means
that
it
stops
vomiting
.
It
is
used
in
dogs
to
prevent
vomiting
such
as
vomiting
caused
by
chemotherapy
(
medicines
used
for
the
treatment
of
cancer
,
some
of
which
are
known
to
cause
vomiting
)
.
In
combination
with
supportive
measures
such
as
other
veterinary
treatment
or
a
special
diet
,
Cerenia
can
also
be
used
in
the
treatment
of
vomiting
(
either
as
injection
or
as
injection
followed
by
tablets
)
.
For
these
purposes
,
Cerenia
can
be
given
for
up
to
five
days
How
does
Cerenia
work
?
Cerenia
blocks
a
neurokinin
1
(
NK1
)
receptor
,
which
acts
in
the
central nervous system
.
How
has
Cerenia
been
studied
?
A
large number
of
studies
with
Cerenia
were
carried out
either
in
laboratory
dogs
or
in
animal
patients
at
veterinary
practises
in
several
European countries
and
in
the
USA
.
What
benefit
has
Cerenia
shown
during
the
studies
?
The
results
of
the
studies
showed
that
Cerenia
was
more
effective
than
the
placebo
:
less
vomiting
was
seen
in
dogs
that
received
the
medicine
than
in
dogs
that
received
a
placebo
,
both
in
the
treatment
or
in
the
prevention
of
vomiting
.
The
treatment
of
a
vomiting
dog
should
be
started
with
the
injection
,
since
vomiting
animals
might
not
be
able
to
keep
a
tablet
down
(
as
they
might
throw
the
intact
tablet
up
again
)
.
For
follow-up
treatment
,
the
animal
owner
can
administer
the
tablets
to
the
dog
.
Also
,
the
treatment
of
vomiting
should
only
be
together with
other
supportive
measure
or
other
veterinary
therapy
while
addressing
the
underlying
causes
of
the
vomiting
.
What
is
the
risk
associated
with
Cerenia
?
Cerenia
was
generally
well
tolerated
when
administered
daily
at
dosages
up
to
5
times
the
recommended
doses
for
an
extended
period of time
(
up
to
3
times
the
recommended
maximum
duration
of
treatment
)
.
What
are
the
precautions
for
the
person
who
gives
the
medicine
or
comes into
contact
with
the
animal
?
Cerenia
does
not
represent
a
particular
risk
for
people
.