Food-Restricted TKIs Associated With Adherence Challenges in CML

Key Clinical Summary

• A 2025 US patient survey found that patients with chronic myeloid leukemia (CML) taking tyrosine kinase inhibitors (TKIs) with food restrictions reported greater treatment-planning burdens and adherence challenges than those taking TKIs without food restrictions.
• Among patients taking Tasigna (nilotinib) or Scemblix (asciminib), 33% reported not dosing on an empty stomach at least once in the previous 30 days, and 29% reported skipping at least 1 dose.
• More than half (56%) of patients taking food-restricted TKIs said they would likely switch to an alternative TKI without food restrictions if recommended by their clinician.

Food-related dosing requirements for certain CML therapies may negatively affect treatment adherence and quality of life, according to findings from a 2025 patient survey conducted among members of the MyLeukemiaTeam online community in the US. The analysis examined how food restrictions associated with Tasigna (nilotinib) and Scemblix (asciminib) influence daily routines, medication adherence, and patient interest in alternative treatment options.

Food Restrictions Associated With Lower Adherence in CML Treatment

The online quantitative survey was conducted from April to May 2025 and included 152 US adults with self-reported CML. Investigators focused on 119 respondents: 55 patients currently taking Tasigna or Scemblix (the food-restriction group) and 64 patients taking other TKIs who had never used either medication (the non-food-restriction group).

Among analyzed participants, current treatments included Tasigna (27%), Scemblix (19%), Sprycel (dasatinib) (18%), Gleevec (imatinib) (17%), Bosulif (bosutinib) (8%), Imatinib (7%), and Dasatinib (4%). The median age was 67 years, 63% were female, 92% were White and non-Hispanic, 61% had Medicare coverage, and 29% had employer-sponsored insurance.

Measures of treatment-related optimism and disease control were similar between groups. Approximately 69% of patients in the food-restriction group and 70% in the non-food-restriction group reported feeling optimistic about their future, while 65% and 67%, respectively, said treatment gave them a sense of control over their disease.

However, patients taking nilotinib or asciminib reported substantially greater logistical challenges. Seventy-six percent said they had to adjust meal timing compared with 34% of patients taking non-food-restricted TKIs. Additionally, 69% reported needing to plan daily activities in advance vs 44% of patients in the comparison group.

Adherence difficulties were also more common among patients subject to food restrictions. Forty-five percent reported difficulty taking medication as prescribed compared with 20% of those taking other TKIs. Among the food-restriction group, 55% experienced at least one food-related dosing challenge, including waking early or staying up late (27%), difficulty following meal-timing instructions (24%), disruptions during holidays or special occasions (18%), and avoiding food in social settings (16%).

During the previous 30 days, 33% reported taking medication without maintaining an empty stomach requirement at least once, and 29% reported skipping at least one dose.

Impact on Quality of Life and Medication Management

The findings suggest that food restrictions associated with certain CML therapies may create meaningful barriers to adherence despite patients reporting positive perceptions of treatment effectiveness. Because long-term TKI therapy is central to disease management in CML, missed doses or deviations from dosing instructions may affect treatment outcomes and safety.

Notably, most respondents (87%) reported discussing food restrictions with their health care providers before initiating therapy. However, only 63% recalled being told why those restrictions were important, and just 3 patients specifically remembered being informed about risks such as QT interval prolongation, cardiac toxicity, or death.

The survey also highlighted potential opportunities for shared decision-making. More than half of patients taking food-restricted TKIs expressed willingness to consider switching to a treatment option without food restrictions if recommended by their clinician. Among those who were unsure or unlikely to switch, 71% indicated that a discussion with their care provider could influence their decision.

Patients Report Challenges Following Empty-Stomach Dosing Requirements

Patient narratives underscored the burden of food-related dosing requirements. One respondent stated, “I feel like I'm constantly watching the clock - when to eat, when not to eat, when to take my pills.”

The survey authors concluded that oncologists should proactively discuss TKI food restrictions, their health benefits, associated risks, and available treatment alternatives that may offer greater flexibility for patients.

Clinician Communication May Influence Treatment Preferences

Survey findings indicate that food restrictions associated with Tasigna and Scemblix may negatively affect adherence, daily functioning, and quality of life among US patients with CML. The results support ongoing clinician-patient discussions regarding dosing requirements and treatment options that may better align with patient lifestyles while maintaining effective disease management.

Reference

Lapidus Glassner H, Douer D, Lee E, Higgins Cronin D. Impact of treatments with food restrictions on adherence and quality of life aspects among CML patients. Blood. 2025;146(suppl 1):2833. doi:10.1182/blood-2025-2833