Cytochrome P450 2D6 CYP2D6 is a polymorphic enzyme responsible for the metabolic activation of tamoxifen to metabolites endoxifen and 4 OH tamoxifen with a significantly greater affinity for the ER and greater ability to inhibit tumor cell proliferation compared with the parent drug tamoxifen or its primary metabolite, N desmethyltamoxifen 3, 4

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