of clinical trials for hepatocellular carcinoma, metastatic melanoma and non-small cell lung cancer (NSCLC). Sunitinib is an oral drug that inhibits the phosphorylation of all the VEGF receptors, PDGFR-ß, KIT FLT3, CSF1R and GDNF. Sunitinib is used in the treatment of advanced renal cell carcinoma and gastrointestinal stromal tumors. Bevacizumab is a humanized monoclonal antibody, which binds selectively to VEGF. It is used as an injection therapy, often in combination with other drugs. It is used in combination with 5-fluorouracil as a first-line treatment of metastatic carcinoma in the colon or rectum. In advanced non-small cell lung cancer bevacizumab (Avastin) is used as a first-line treatment in combination with paclitaxel and carboplatin. It can also be used in the treatment for breast cancer and kidney cancer. Lenvatinib and vandetanib are used for the treatment of progressive and locally advanced differentiated thyroid cancer (DTC). Pazopanib and axitinib are used orally for the treatment of advanced renal cell carcinoma. Cabozantinib has the same indication but it is only used on patients who have already received an anti-angiogenic therapy. Regorafenib is administered orally for the treatment of colorectal cancer, gastrointestinal stromal cancer and hepatocellular carcinoma. Nintedanib is used for the treatment of idiopathic pulmonary fibrosis. Tests for liver function have to be made to modify doses before the therapy can start. Apatinib is used for the treatment of advanced gastric cancer. It is often diagnosed in late stages because there are no early signs or symptoms. Mechanism of action Binding to VEGF receptor induces dimerization, which modifies the conformation in the intracellular domain. This modification leads to the exposure of the ATP-binding site, which causes ATP binding on the receptor and also transphosphorylation on specific tyrosine residues. Tyrosine phosphorylation on the receptor is regulated by internalization, degradation and by dephosphorylation through different protein tyrosine phosphatases. This can then lead to the initial receptor signal transduction cascade, which activates several downstream enzymatic pathways. The signaling inhibition of VEGFR is through tumor vessels and not the tumor cells. Reduction of VEGF expression reduces blood flow to tumor and stops tumor angiogenesis. Adverse Effects VEGF inhibitors in the treatment of cancer often cause adverse effects. Treatment with VEGF inhibitors suppresses cellular signalling pathways that are important in microvasculature regulation and maintenance. The effects on normal organs can then lead to vascular disturbances and regression of blood vessels. FDA has approved three drugs, bevacizumab, sunitinib and sorafenib,