GUARDANT HEALTH INC (GH) Q1 2026 Earnings Call Transcript
Guardant Health, Inc., a precision oncology company, provides blood tests, data sets, and analytics in the United States and internationally. The company offers Guardant360; Guardant360 LDT; Guardant360 CDx; Guardant360 Response Test; Guardant360 TissueNext Test; GuardantINFINITY Test; GuardantConnect, an integrated software-based solution designed for clinical and biopharmaceutical customers to connect patients tested with assays with actionable alterations with potentially relevant clinical studies; GuardantOMNI Test for advanced stage cancer; and GuardantINFORM, an in-silico research platform for tumor evolution and treatment resistance across various biomarker-driven cancers. It also offers Shield Test; Guardant Reveal Test for neoadjuvant and adjuvant treatment selection in early-stage cancer patients; Smart Liquid Biopsy Platform; and Guardant Galaxy, a suite of advanced analytical technologies to enhance the performance and clinical utility of cancer tests. Further, it offers development services, including companion diagnostic development and regulatory approval, clinical study setup, monitoring and maintenance, testing development and support, and kits fulfillment related services to biopharmaceutical companies and medical institutions. Guardant Health, Inc. has a research collaboration agreement with the Parker Institute for Cancer Immunotherapy to study the correlation between molecular cancer biomarkers and patient response to immunotherapy treatment across various types of cancer. The company was incorporated in 2011 and is headquartered in Palo Alto, California.
Guardant delivered 2025 revenue of $982M with accelerating oncology and screening growth, expanding Shield with ADLT reimbursement, and guiding to 2026 revenue of $1.25–$1.28B while targeting cash flow breakeven by 2027.
⭐ Key Highlights
✔Positive Signals
- Shield revenue growth and ADLT reimbursement establishing favorable ASPs and gross margins
- Medicare CRC surveillance coverage driving MRD and data expansion for Reveal
- Strong oncology volume growth and rapid adoption of Smart Platform applications
- MetaSight Diagnostics acquisition to accelerate multi-disease detection and AI data capabilities
- Strategic biopharma partnerships (e.g., Merck) and expanded CDx approvals expanding the pipeline
✖Negative Signals
- ADLT pricing for Guardant360 not baked into 2026 guide, creating potential upside vs. downside risk
- Shield ASP mix shift from Medicare to under-65 may pressure margins in 2026
- Shield launch remains early-stage with potential upside dependent on ACS guidelines and international expansion
- Continued screening burn from commercial expansion may pressure near-term profitability
- Regulatory and reimbursement timing risk for new tests (e.g., Guardant360 Liquid CDx, Reveal Ultra)
📊Financial Results
- Q4 revenue $281.3 million, up 39% YoY; full-year revenue $982.0 million, up 33% YoY
- Oncology revenue $189.9 million in Q4, up 30%; full-year oncology revenue $683.6 million, up 26%; tests ~79,000 in Q4, up 38%
- Non-GAAP gross margin: Q4 66%; full-year 66% (improved from 62% in 2024; mainly due to lower Reveal cost per test and Shield margin improvements)
- Screening revenue $35.1 million in Q4; Shield ASP ~ $850; Shield cost per test around $450; Shield non-GAAP gross margin 52% in 2025
- Adjusted EBITDA loss: Q4 $64.9 million; full-year loss $220.9 million; cash burn $233 million in 2025
🔮Future Guidance
- 2026 revenue guidance $1.25–$1.28 billion, up 27–30% YoY; oncology growth 25–27% and volume growth ~30%
- Screening revenue guidance $162–$174 million; 210,000–225,000 Shield tests
- Non-GAAP gross margin 64–65% in 2026; OPEX $1.03–$1.05 billion (up 14–16% YoY)
- Free cash flow burn guidance of $185–$195 million in 2026; core business expected to be free cash flow positive
- Long-term target: 2028 revenue of $2.2 billion; ongoing catalysts include Guardant360 Liquid CDx, ESR1 monitoring, Reveal Ultra, ACS guideline updates, Quest/PathGroup contributions
💡Interesting Insights
- MetaSight acquisition could materially accelerate multi-disease detection and AI-driven data insights, potentially compressing R&D timelines and enhancing MD/EMR data integration
Detailed Analysis
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