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priligy in usa Experimental and clinical evidence suggests that more than one mechanism may beinvolved, including the development of partial agonistic activity of tamoxifenwith stimulation of tumor regrowth, 11, 13, 14, 16, 17 alteration or mutation ofthe estrogen receptor, 16, 18 20, 21 clonal selection of an estrogen receptor negativephenotype, 16, 20, 22 development of metabolic tolerance resulting in inadequateintra tumoral tamoxifen concentrations, 16, 20, 22 and increased gene expressionand growth factor production by tumor cells possibly leading to autocrinestimulation