Snapshot
Guardant Health, Inc. reported $302M of revenue in Q1 2026, up 48.3% year over year, with diluted EPS of $-0.85 and an operating margin of -40.2%.
- Revenue
- $302M
- YoY growth
- +48.3%
- Diluted EPS
- $-0.85
- Operating margin
- -40.2%
What management said
- •Notably, our commercial flywheel has achieved a new level of velocity, delivering our fastest year-over-year percentage revenue growth in the last five years and surpassing the $1 billion trailing 12-month revenue milestone.
- •Patient outcomes like this are one of the many reasons we have benefited from accelerating adoption and growth.
- •Turning to our revenue performance in slide four, we had a phenomenal start to 2026, delivering $302 million of revenue in Q1, representing 48% year-over-year growth.
- •The growth was strong and broad-based across our oncology, biopharma and data, and screening business lines.
- •Taking a closer look at our oncology business in slide five, oncology revenue growth accelerated to 36% year-over-year, driving Q1 revenue of $205 million.
- •This was the highest year-over-year percentage growth in oncology volume we've seen in nearly three years, with strength across all products.
- •Turning to slide six, our 47% year-over-year volume growth reflects the increasing breadth of our portfolio across both therapy selection and MRD.
- •Guardant360 Liquid delivered 30% volume growth year-over-year, while Guardant360 Tissue was our second fastest-growing product.
- •Smart Platform innovation continues to translate directly into volume growth for both products, with InfinityAI powering a steady cadence of new clinical applications that are driving deeper adoption among oncologists.
- •We have a strong pipeline of additional Smart Apps in development, and we look forward to continuing that cadence.
- •The result is a compounding flywheel wherein data drives better insights, which in turn fuels volume growth and strengthens our data advantage.
- •Turning to slide eight to take a closer look at our Reveal data pipeline.
What went well
- •Guardant delivered $302 million of Q1 revenue, up 48% year-over-year, its fastest year-over-year percentage revenue growth in the last five years, with broad-based strength across oncology, biopharma and data, and screening.
- •The company surpassed the $1 billion trailing twelve-month revenue milestone.
- •Oncology revenue grew 36% to $205 million on roughly 86,000 tests (up 47%), the highest year-over-year oncology volume growth in nearly three years, with Reveal volumes up over 100%.
- •Shield screening revenue reached $42 million on approximately 44,000 tests, versus $6 million on roughly 9,000 tests a year earlier, with adherence above 90%.
- •Non-GAAP gross margin rose to 66% from 65%, helped by lower Guardant360 Liquid cost per test from the NovaSeq X transition and screening gross margin improving from 18% to 56%.
- •The CDx franchise now spans 26 approvals across the U.S., Japan, and Europe, including new approvals and a multi-year companion-diagnostic agreement with Merck.
What went wrong
- •Adjusted EBITDA loss was $59 million, flat versus the prior-year period, and free cash flow burn was $71 million versus $67 million, partly due to a higher company-wide bonus payout.
- •The Oncologic Drugs Advisory Committee voted six to three against the claim that camizestrant demonstrated clinically meaningful benefit, an outcome tied to a partner therapy that could affect a Guardant360 Liquid ESR1 monitoring launch.
- •Shield ASP is expected to tick down through the rest of the year as the mix shifts toward under-65 commercial patients who are not yet covered.
- •ACS guideline inclusion for Shield has still not been published despite being anticipated for over a year.
Guidance changes
| Metric | Period | Previous | Current | Change |
|---|---|---|---|---|
| Total revenue | Full year 2026 | — | $1.30B-$1.32B (32%-34% growth) | raised |
| Oncology revenue growth | Full year 2026 | — | 28%-29% (volume growth greater than 35%) | raised |
| Screening revenue | Full year 2026 | — | $186M-$198M (Shield volume ~230,000-245,000 tests) | raised |
| Biopharma and data revenue growth | Full year 2026 | — | low double-digit range | reaffirmed |
| Non-GAAP gross margin | Full year 2026 | — | 64%-65% | reaffirmed |
| Non-GAAP operating expenses | Full year 2026 | — | $1.05B-$1.07B (16%-18% growth) | new |
| Free cash flow burn | Full year 2026 | — | $185M-$195M (improvement YoY) | reaffirmed |
Performance breakdown
| Metric | YoY change | Reason |
|---|---|---|
| Total revenue | +48% | Broad-based momentum across oncology, biopharma and data, and screening, with the commercial flywheel reaching new velocity. |
| Oncology revenue | +36% | 47% test volume growth across the portfolio driven by Smart Platform and InfinityAI clinical applications. |
| Guardant360 Liquid volume | +30% | Expanding clinical utility and continued Smart Apps traction, plus share gains and broader physician adoption. |
| Reveal volume | exceeding 100% | Strong MRD adoption across indications and enthusiasm for the new therapy response monitoring use case in its first full quarter post-launch. |
| Screening revenue | from $6M to $42M | Roughly 44,000 Shield tests versus 9,000 a year earlier, plus the Medicare rate step-up from $920 to $1,495 effective April 1, 2025. |
| Biopharma and data revenue | +17% | Sustained demand across sample testing, companion diagnostic projects, and data products. |
| Shield non-GAAP cost per test | from $520 to $420 | Higher volumes, disciplined cost management, and efficient lab operations. |
Earnings call themes & trends
| Topic | Previous mention | Current period | Trend |
|---|---|---|---|
| Shield commercial momentum | Volume tracked as expected through January and February | Accelerated sharply in March from DTC/influencer campaigns and the Quest partnership launch, prompting a raised full-year guide | accelerating |
| Reveal MRD and reimbursement | Therapy response monitoring launched in Q4 2025 | Fastest-growing product with data packages submitted to MolDX for breast surveillance and IO/chemo monitoring, representing ASP upside catalysts | expanding |
| InfinityAI / Smart Platform data moat | — | Data repository spans over 1 million patient samples and 500,000 epigenetic profiles, powering 25 of 38 AACR abstracts and new Smart Apps | deepening |
| Quest Diagnostics collaboration | Prior outlook excluded Quest benefit | Launched nationwide in late Q1, fast-tracking EMR connectivity to more than 650,000 HCPs with positive early contributions now factored into guidance | ramping |
| Camizestrant / SERENA-6 monitoring | — | AdCom voted six to three against clinically meaningful benefit; management views Reveal therapy monitoring and MolDX submissions as the primary path, with any approval as upside | uncertain |
Q&A summary
Why did you raise the Shield volume guide and how much is Quest versus other drivers?
January and February tracked as expected, but March saw outsized momentum from DTC/influencer campaigns and the Quest go-live with EMR connectivity all hitting at once; some Quest contribution is now in the new guide, though management is still gathering data on its incremental impact.
What is driving Guardant360's 30% growth a decade after launch and how much of guidance does it represent?
Growth is broad-based from the Smart Liquid Biopsy platform's step-change capabilities, with share gains plus greater depth and breadth among physicians; the full-year Guardant360 assumption was nudged up from roughly 20% on the strong quarter.
What is driving Reveal's over-100% growth and what reimbursement catalysts should we watch?
Growth spans CRC, breast, and lung surveillance plus the new therapy monitoring use case; MolDX submissions for breast surveillance and IO/chemo monitoring are the key catalysts, with volume as the leading indicator ahead of reimbursement.
What is the Shield ASP assumption and the Medicare mix for the rest of the year?
Q1 was predominantly Medicare fee-for-service and Medicare Advantage, driving a strong ASP near $800; the guide implies roughly $775 average for Q2-Q4 as mix skews toward under-65 commercial patients not yet covered.
How sustainable are Guardant360 Tissue share gains and the ASP upside from whole transcriptome?
Management views the growth as sustainable, expecting FDA approval of Guardant360 Liquid to streamline ordering; tissue will gain the same Smart Apps over time and pursue ADLT status through its own regulatory pathway to lift ASP further.
What are the plans for the commercial sales force and where is incremental OpEx going?
On oncology, territories are split and reps added where revenue per territory supports positive ROI; on screening, incremental gross profit is reinvested into building the sales force and DTC marketing, with rep quality continuing to improve.