irinotecan but decreases the AUC of fluorouracil and neomycin, so it is cautionary to administer sorafenib with these drugs as it may alter the plasma concentration. Sorafenib is metabolized by CYP3A4 and UGT1A9. This means that drugs metabolized by these pathways have to be carefully administered. Sorafenib's inhibition of UGT1A9 and UGT1A1 may increase plasma concentration of other drugs. The same goes for the CYP2B6 and CYP2C8 pathways, they are inhibited by sorafenib. Giving sorafenib in combination with rifampicin or inducers of CYP3A4 can decrease plasma concentration of sorafenib. CYP3A4 inhibitors are unlikely to affect sorafenib. Sorafenib is a competitive inhibitor of CYP2C19, CYP2D6 and CYP3A4. It inhibits P-glycoprotein, therefore it can increase the plasma concentration of drugs which are P-glycoprotein substrates. Pazopanib is metabolized in the liver by CYP3A4 enzyme. Strong CYP3A4 inhibitors, other than pazopanib, can increase the plasma concentration of pazopanib, and CYP3A4 inducers will do the opposite. Grapefruit juice is a CYP3A4 inhibitor and should be avoided when taking pazopanib. It is also a weak inhibitor of other liver enzymes, CYP2C8 and CYP2D6. Axitinib is metabolized by CYP3A4 and UGT1A1. Strong inhibitors of CYP3A4 will increase the plasma concentration of axitinib, while weak inhibitors have less effect on the plasma concentration. Strong inducers of CYP3A4 will decrease the plasma concentration of axitinib and should be avoided. Pipeline drugs Lucitanib is a tyrosine kinase activity inhibitor, highly selective for VEGFR types 1-3, FGFR types 1-2 and PDGFR alpha/beta. Tumor types such as breast carcinoma show amplification of fibroblast growth factor related genes. Simultaneous inhibition of VEGF and FGF receptors in FGFR1 dependent tumors could be therapeutically advantageous. Lucitanib has been shown to have promising efficacy, a manageable side-effect profile and clinical benefits in both FGF-aberrant and angiogenesis-sensitive populations leading to a phase II program being planned. Motesanib is a small-molecule multikinase inhibitor highly selective for VEGFR 1-3, PDGFR and KIT. The drug has shown anti-tumor activity as a monotherapy in advanced solid tumors. Vatalanib is an antiangiogenic VEGFR inhibiting molecule which is being researched as a potential treatment of solid tumors. Vatalanib inhibits VEGFR 1-4 although it has greater potency as an inhibitor of VEGFR 1-2. At concentrations under 10 μM, Vatalanib does not have cytotoxic or antiproliferative effects on cells that do not express VEGF. Specific inhibition of tumor-induced angiogenesis like the inhibition by Vatalanib can both prevent ongoing growth of tumors and the metastatic potential.