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    GH
    Earnings call· Mar 2026(Q1 FY26)

    Guardant Health Q1 FY26 earnings call GH

    May 7, 2026 Source

    Executive summary

    Guardant Health Q1 FY26 — Strong Revenue Growth and Shield Momentum

    Guardant Health delivered a strong Q1 FY26, driven by accelerated growth across its Oncology, Biopharma & Data, and Screening segments, surpassing $1 billion in trailing 12-month revenue. The company raised its full-year revenue guidance, reflecting significant momentum in Shield testing and continued strength in oncology, while strategically reinvesting in commercial expansion and product development.

    Highlights

    5

    • Total revenue of $302 million, up 48% year-over-year, marking the fastest growth in the last 5 years.

    • Oncology revenue accelerated to $205 million, growing 36% year-over-year, with test volumes rising 47%.

    • Shield testing revenue reached $42 million, a significant increase from $6 million in Q1 FY25, driven by 44,000 tests.

    • Non-GAAP gross margin improved to 66% in Q1 FY26, up from 65% in the prior year period.

    • Full-year 2026 revenue guidance was raised to a range of $1.30 billion to $1.32 billion, representing 32% to 34% growth.

    Concerns

    3

    • Adjusted EBITDA loss remained at $59 million in Q1 FY26, consistent with the prior year period.

    • Free cash flow burn increased to $71 million in Q1 FY26, up from $67 million in the prior year period.

    • Sales and marketing expense rose significantly to $154 million in Q1 FY26, a 64% increase year-over-year.

    Guidance & targets

    8
    CategoryTargetConfidence
    Full-year 2026 Revenue
    $1.30B-$1.32B
    high materiality
    High
    Full-year 2026 Oncology Revenue Growth
    28%-29%
    medium materiality
    High
    Full-year 2026 Biopharma & Data Revenue Growth
    low double-digit range
    medium materiality
    High
    Full-year 2026 Screening Revenue
    $186M-$198M
    high materiality
    High
    Full-year 2026 Non-GAAP Gross Margin
    64%-65%
    medium materiality
    High
    Full-year 2026 Non-GAAP Operating Expenses
    $1.05B-$1.07B
    medium materiality
    High
    Full-year 2026 Free Cash Flow Burn
    $185M-$195M
    high materiality
    High
    Company-wide Cash Flow Breakeven
    achieve by end of 2027
    high materiality
    High

    Segment performance

    3
    SegmentRevenueYoYQoQMargin
    Oncology
    Oncology test volumes rose from 59,000 in the prior year period. Strength across all products, with Guardant360 Liquid benefiting from Smart App adoption and Reveal from MRD and therapy response monitoring.
    86,000 tests47% volume growthGuardant360 Liquid volumes: 30% growthGuardant360 Tissue: second fastest-growing productReveal: >100% volume growth
    		$205M36%——
    Biopharma & Data
    Reflecting sustained demand and continued strength across sample testing, companion diagnostic projects, and data products.
    		$53M17%——
    Screening
    Increase primarily driven by higher Shield test volumes. Volume tracked in line with expectations through January and February, with momentum building through March following Quest partnership launch and successful marketing programs.
    44,000 testsQ1 FY25 revenue: $6MQ1 FY25 tests: 9,000
    		$42M———

    Operational metrics

    27
    Non-GAAP Gross Margin
    66%up from 65% in Q1 FY25
    Q1 FY26

    Improvement primarily driven by lower Guardant360 Liquid cost per test and improved screening gross margins.

    Guardant360 Liquid Sequencing Cost Per Test Reduction
    $200
    Q1 FY26 vs Q1 FY25

    Result of ongoing transition to NovaSeq X, which will be completed in May 2026.

    Screening Non-GAAP Gross Margin
    56%up from 18% in Q1 FY25
    Q1 FY26

    Improvement driven by increase in Shield ASP and decrease in Shield non-GAAP cost per test.

    Shield Non-GAAP Cost Per Test
    $420down from $520 in Q1 FY25
    Q1 FY26

    Result of higher volumes, disciplined cost management, and efficient lab operations.

    Shield Cost Per Test at Scale
    $200
    future

    Expected to decline driven by further volume growth, workflow efficiencies, and automation in 2027.

    Non-GAAP Operating Expenses
    $268Mup 34%
    Q1 FY26

    Primarily driven by commercial investment.

    Sales and Marketing Expense
    $154Mup from $94M in Q1 FY25
    Q1 FY26

    Reflects continued investment in screening sales infrastructure, HCP and DTC marketing programs, and oncology revenue growth support.

    Cash and Investments Balance
    $1.2B
    Q1 FY26 end

    Ended the quarter with approximately $1.2 billion in cash and investments.

    Shield ASP (Medicare Fee-for-Service Rate)
    $1,495up from $920
    2026 and 2027

    Medicare rate step-up went into effect on April 1, 2025, following Shield's ADLT designation. Established for 2026 and 2027 based on 2025 payments.

    Guardant360 Liquid ASP
    $3,000-$3,100stable sequentially
    Q1 FY26

    Average selling price for Guardant360 Liquid.

    Guardant360 Tissue ASP
    >$2,000
    Q1 FY26

    Average selling price for Guardant360 Tissue.

    Reveal ASP
    $600-$700
    Q1 FY26

    Average selling price for Reveal. Favorable MolDx outcomes could provide upside.

    Out-of-Period Revenue
    $22Mconsistent with quarterly trends
    Q1 FY26

    Total out-of-period revenue for the quarter.

    Guardant360 Liquid NovaSeq X Transition
    completed
    May 2026

    Transition to NovaSeq X for Guardant360 Liquid sequencing.

    Shield Blood Collection Tubes
    2reduced from 4-tubes
    current

    FDA approval received to reduce the amount of blood collected for Shield test.

    Shield Multi-Cancer Detection Report Coverage
    9
    current

    Covers additional cancer types behind CRC, including lung, breast, ovarian, and pancreatic.

    DTC and Influencer Campaigns Impressions
    >1 billion
    Q1 FY26

    Generated by first comprehensive DTC campaign spanning TV, digital, and influencer channels.

    HCPs Reached by March Campaign
    200,000
    March Q1 FY26

    Targeted messaging emphasizing unscreened Americans and Shield's FDA approval and Medicare coverage.

    Quest EMR Connectivity
    >650,000
    late Q1 FY26

    Fast-tracked EMR connectivity through collaboration with Quest Diagnostics.

    Phlebotomists Network
    40,000
    current

    Nationwide network for convenient phlebotomy access.

    Quest Patient Service Centers
    8,000
    current

    Available for patient phlebotomy access.

    Shield Adherence Rate
    >90%
    current

    High adherence rate, a key differentiator versus other noninvasive modalities.

    Oncology Test Volumes
    59,000
    Q1 FY25

    Oncology test volumes in the prior year period.

    Data Repository Patient Samples
    >1 million
    current

    Data repository harnesses insights from over 1 million patient samples.

    Data Repository Epigenetic Profiles
    500,000
    current

    Data repository includes 500,000 epigenetic profiles across more than 100 tumor types.

    AACR Abstracts Presented
    38
    this year

    Presented spanning the entire oncology portfolio, with 25 featuring InfinityAI generated findings.

    CDx Approvals
    26
    current

    CDx franchise now spans 26 approvals across the U.S., Japan, and Europe.

    Industry KPIs

    1
    MetricValueDetails
    Adjusted EPS EBITDA leverage guidance-$59MUSD

    Product announcements

    3
    ProductTypeDetails
    Shield blood collectionupdate
    Guardant360 Tissue RNA testingexpansion
    Shield Multi-Cancer Detection (MCD) reportlaunch

    Deals & partnerships

    4
    MerckDevelop companion diagnostics and commercialize novel therapiesmultiyear

    Multiyear agreement with Merck to develop companion diagnostics and commercialize novel therapies.

    NuvalentDevelop companion diagnostics with an initial focus on Guardant360 Tissue

    Collaboration with Nuvalent to develop companion diagnostics with an initial focus on Guardant360 Tissue.

    Quest DiagnosticsNationwide collaboration for Shield colorectal cancer screening

    Quest collaboration launched nationwide in late Q1, opening doors for Guardant in health systems and physician practices and fast-tracking EMR connectivity to more than 650,000 HCPs.

    ManulifeExpansion of Shield multi-cancer detection in Asia

    Expansion of Shield multi-cancer detection in Asia through a partnership with Manulife, serving over 13 million customers. Initially launched in Hong Kong, the Philippines, and Singapore.

    Risks & headwinds

    1
    Camizestrant FDA approval uncertaintycoming months

    Oncologic Drugs Advisory Committee voted [ 6 to 3 ] against the claim that camizestrant demonstrated clinically meaningful benefit in HR-positive HER2-negative metastatic breast cancer.

    Mitigation: FDA retains full discretion over its final decision; broader consensus that ctDNA companion diagnostic therapy monitoring represents the future of precision oncology care.

    What to watch in Q2 FY26

    5

    Shield Volume Trajectory

    next quarter
    Current44,000 tests in Q1 FY26, strong momentum in March
    Targetcontinued sequential growth of ~10,000 tests per quarter

    Why it matters

    Sustained Shield volume growth is critical for achieving full-year guidance and demonstrating market adoption of the screening product.

    our guide for this year now for Shield, when you do the calculation, it kind of implies an average of about maybe a little bit over 10,000 sequential growth like Q-over-Q.

    Q&A highlights

    7

    What is the confidence level for April Shield volumes, and how much of the raised guidance is attributable to the Quest collaboration versus other drivers?

    Management expressed high confidence in the new guidance, noting strong momentum in March driven by DTC campaigns, influencer campaigns, and the Quest launch. Early indications from Quest are positive and factored into the guide, but the company will continue to monitor its incremental contribution.

    “Based on the trends that we've seen in March, and it's -- we don't want to get into Q2 commentary, but based on everything that we've seen, gives us a lot of good confidence of what we can deliver in this year.”

    asked by Mark Massaro · answered by AmirAli Talasaz

    2 min read6 chapters

    Detailed Narrative

    01

    Q1 FY26 Performance Highlights

    Guardant Health reported a robust Q1 FY26, with total revenue reaching $302 million, marking a 48% year-over-year increase and the fastest growth in five years. This performance was broad-based across Oncology, Biopharma & Data, and Screening segments, pushing the company past the $1 billion trailing 12-month revenue milestone. The strong results validate the strategic vision of delivering actionable insights across the care continuum.

    02

    Oncology Segment Strength

    The oncology business saw accelerated growth of 36% year-over-year, generating $205 million in revenue. Oncology test volumes surged 47% to approximately 86,000 tests, up from 59,000 in the prior year period. This growth was driven by Guardant360 Liquid (30% volume growth) and Reveal (over 100% volume growth), reflecting expanding clinical utility, smart platform innovation, and strong adoption across the cancer care continuum.

    03

    Shield Screening Momentum

    Shield testing revenue reached $42 million from approximately 44,000 tests in Q1 FY26, a significant increase from $6 million and 9,000 tests in Q1 FY25. This growth was fueled by improved sales rep productivity, successful direct-to-consumer (DTC) and influencer campaigns (generating over 1 billion impressions), and the nationwide launch of the Quest collaboration, which contributed to strong momentum exiting March.

    04

    Operational Efficiency and Financial Outlook

    Non-GAAP gross margin improved to 66% in Q1 FY26, primarily due to lower Guardant360 Liquid cost per test (reduced by nearly $200 YoY) and improved screening gross margins. The company raised its full-year 2026 revenue guidance to $1.30 billion to $1.32 billion and reiterated its commitment to achieving company-wide cash flow breakeven by the end of 2027, while strategically reinvesting in commercial expansion.

    05

    Strategic Product Developments

    Guardant Health continues to advance its product pipeline, with Guardant360 Liquid's FDA review on track to become the most comprehensive FDA-approved liquid biopsy for therapy selection. Guardant360 Tissue received a second major platform upgrade, expanding RNA testing to whole transcriptome. Reveal is expanding its utility with new therapy response monitoring and MolDx submissions for breast cancer surveillance and immuno-oncology monitoring.

    06

    Multi-Cancer Detection and Patient Experience

    The company received FDA approval to reduce Shield blood collection to two tubes from four, enhancing patient experience. Shield Multi-Cancer Detection (MCD) was launched in Asia via a partnership with Manulife and is being offered to US Shield CRC patients who opt-in, establishing a scalable platform for clinical data generation. The MCD report covers findings across 9 additional cancer types.

    AI-generated summary of the company’s earnings call. Not investment advice.