Guardant Health at Morgan Stanley Conference: Innovations in Cancer Diagnostics

On Monday, 08 September 2025, Guardant Health (NASDAQ:GH) presented at the Morgan Stanley 23rd Annual Global Healthcare Conference, highlighting strategic advancements and challenges. The company emphasized its commitment to innovation in cancer diagnostics, while also acknowledging the path to achieving profitability by 2028.

Key Takeaways

• Guardant Health is expanding Shield’s accessibility through a partnership with Path Group.
• Medicare rate increases are driving higher ASPs for Guardant360.
• The company is on track to achieve cash flow break-even by the end of 2028.
• Future growth is expected from new smart liquid biopsy applications and expanded commercial coverage.

Financial Results

• ASPs: Guardant360’s ASPs are currently between $3,000 and $3,100, with a target increase to $3,200-$3,300. Reveal’s ASPs are just over $600, aiming for $1,000 by 2028.
• Growth: The oncology business is projected to achieve 20% revenue growth this year, with overall cash flow break-even anticipated by the end of 2028.
• Medicare Rate Increase: Effective April 1, 2024, the ADLT rate rose from $920 to $1,495, aligning Medicare Advantage payers with this rate.

Operational Updates

• Shield: The partnership with Path Group, which serves over 15,000 physicians, is set to accelerate Shield’s market reach. V2 data shows improved sensitivity in stage 1 cancer detection. Guardant Health plans to have over 250 sales reps promoting Shield by year-end.
• Guardant360: The company has launched 11 smart liquid biopsy applications, enhancing cancer monitoring and therapy selection.
• Reveal: Now gross margin positive, with test costs reduced to under $500. Approximately 50% of Reveal’s volume is colorectal cancer, followed by breast and lung.

Future Outlook

• Shield: Plans to submit upgrades to the FDA, with expectations for broader commercial coverage following ACS and USPSTF guideline inclusion.
• Guardant360: Integration of smart liquid biopsy capabilities into Reveal is underway, with research on 12-15 tumor types in progress.
• General: The business, excluding screening, is expected to be cash flow break-even by the end of this year.

Q&A Highlights

• MRD Market: A tissue-free approach is anticipated to dominate the market within the next decade.
• Reveal: Breast cancer reimbursement is expected by the end of this year or early next year.

Guardant Health’s strategic focus on innovation and operational efficiency positions the company for future growth. For a detailed discussion, refer to the full transcript below.

Full transcript - Morgan Stanley 23rd Annual Global Healthcare Conference:

Kalam Tichumas, Life Sciences team, Morgan Stanley: I think we can get started, everyone. Kalam Tichumas here from the Life Sciences team at Morgan Stanley. We’re pleased today to be joined by Helmy Eltoukhy, Chairman, Co-Founder, and Co-CEO; AmirAli Talasaz, Co-Founder and Co-CEO; and we have Mike Bell, CFO, as well with us. Before we get started, I have to read you some disclosures. Please see the Morgan Stanley Research Disclosure website at www.morganstanley.com/researchdisclosures. Maybe let’s start off kind of high level, Helmy. It’s now 13 years post-founding. Each year, obviously, brings a lot of new stuff to discuss. Maybe just reflect on how you feel the company’s progressed over this time and whether where we sit today aligns with your mission back in 2012.

Helmy Eltoukhy, Chairman, Co-Founder, and Co-CEO, Guardant Health: Yeah, look, when we started the company, we had a crazy idea of having a blood test, an annual physical that could sort of keep cancer at bay and detect it early. We wanted to do that systematically by launching tests in therapy selection, MRD, and screening. Here we are 13 years later with the first company that has Medicare-reimbursed products across all three areas of patient care. On the one hand, it was part of the plan. On the other hand, looking back, it’s pretty amazing that we actually set out to do it and accomplish that now. Obviously, the details are very different from a technology point of view of how we actually got there versus how we thought we would get there.

I think it’s a testament to the team, to the strong team that we’ve built, and the grit and resilience and perseverance we’ve had despite a number of twists and turns to get to this point where we’re impacting now potentially millions of patients around the world with more time free from the disease.

Kalam Tichumas, Life Sciences team, Morgan Stanley: Great. I want to begin actually on screening with you, AmirAli. On the Path Group partnership you announced this morning, exciting stuff. Maybe just frame up what this partnership means for Shield, bigger picture. Obviously, we are filled with investors here, so we want to hear about the revenue upside as well.

Helmy Eltoukhy, Chairman, Co-Founder, and Co-CEO, Guardant Health: Yeah, sure. We are very excited about actually the opportunity that Shield could have. It has the potential to be the biggest diagnostic plan ever outside COVID testing. We are very excited with the early adoption that we are seeing in the marketplace for Shield. There is a strong pull. We want to make sure that we provide access to the patients who are eligible for Shield testing as soon as possible and accelerate that distribution plan that we are building. We are doing it through our own direct sales force and building EMR integration with different health systems. We are also exploring partnership opportunities to accelerate some of those plans. This Path Group announcement that we had this morning is one of the opportunities that we are very excited about. Path Group is expanding very fast within the Southeast.

They are integrated with 250 health systems and sites, serving over 15,000 physicians, majority PCPs, OB-GYN, and GI. They are testing over 5 million patients with Path Group tests. They are the entity that they call themselves physician-led distribution network, physician-led for physicians. We are excited to be in this partnership. It would really accelerate the accessibility of Shield for some patients in the community and the rural area. In terms of opportunity and the upside for it, we didn’t count on this partnership in 2025 guidance that we set out a few months ago. Still, it’s going to take us some time to integrate with Path Group. Once we get integrated, hopefully, it would be an interesting upside for us as we go to 2026.

Kalam Tichumas, Life Sciences team, Morgan Stanley: Got you. We also saw data from V2 last week. Just talk us through how that stacked up versus your expectations.

Helmy Eltoukhy, Chairman, Co-Founder, and Co-CEO, Guardant Health: Yeah, actually, what we saw was 2x higher analytical sensitivity. Once we unblinded the clinical database, what it translated was 7% improvement in stage 1 performance relative to the current FDA Shield approved and blended sensitivity improvement of plus 1%. I think the interesting part and positive part is obviously the pathway that we figured out based on the data and biological insight that we have, how we could improve stage 1 performance for Shield. As a reminder, the currently FDA-approved Shield has very, very high sensitivity in detecting stage 2, 3, 4, like we saw 100% in that pivotal trial when we ran Shield two years ago. The ones that we are missing were stage 1. Seeing that level of improvement in stage 1 was validating the roadmap and the understanding of science and biology and technology roadmap that we have.

We are hoping to see more than plus 1% blended sensitivity improvement when we are making such an improvement with stage 1. We take any small wins as a win. This endorses the pathway that we have for future upgrade for this test. We are also very excited about progress we are making on the multi-cancer detection front for Shield. Not only are we working to improve CRC performance of the test, in the near future, we are going to broaden access for patients to get access to multi-cancer detection findings for the same Shield test. Patients and physicians are going to have the access to the test that can look at up to 10 different cancer types.

Kalam Tichumas, Life Sciences team, Morgan Stanley: Maybe nitpicking here, but I think stage 3 sensitivity dropped down to 96%. What happened there? I think V1 was 100%, right?

Helmy Eltoukhy, Chairman, Co-Founder, and Co-CEO, Guardant Health: Yeah, I think some of it is just really like the variability of the cohorts when you’re actually running a bunch of these samples. We know the technology has very, very high performance at stage 10 and above. Sometimes you may get one that’s maybe a little bit harder than the other one. That’s what we dealt with. If that one was not there, maybe we were talking about a little bit better blended sensitivity for Shield as well.

Kalam Tichumas, Life Sciences team, Morgan Stanley: On the commercialization plans for V2, any change in timelines or as you communicated before?

Helmy Eltoukhy, Chairman, Co-Founder, and Co-CEO, Guardant Health: We just got to the data readout, and we are planning to put any of the Shield upgrades that we are going to have in front of the FDA. We go from there.

Kalam Tichumas, Life Sciences team, Morgan Stanley: How much better could this product get?

Helmy Eltoukhy, Chairman, Co-Founder, and Co-CEO, Guardant Health: I think the science of liquid biopsy is interesting. I think there are some literature that actually has come up that even advanced adenomas have biomarkers and similar biomarkers to colorectal cancer, but at a much, much lower level of shedding in circulation. The science is there that even some of these harder-to-catch adenomas, their signature is there. It’s just a matter of, would you have the sensitivity of finding that lower and lower level of shedding in circulation. Now through V2 path and algorithm improvement with the additional data that we had at the time of between V1 and V2, we got to 2x improvement. Time will tell how much more we can improve. This is an AI-based, learning-based kind of algorithm that we have. In theory, more and more data we capture, better biological insight we are going to find, and the algorithm over time would get better.

With the scale of Shield adoption that we are seeing in the market, the potential is out there for this algorithm to be able to distinguish this cancer signature in blood more accurately over time. Time will tell.

Kalam Tichumas, Life Sciences team, Morgan Stanley: Great. Just on the guideline side, CLC, you’ve got Shield now included in the NCCN guidelines. What read-throughs can we take to ACS guidelines there?

Helmy Eltoukhy, Chairman, Co-Founder, and Co-CEO, Guardant Health: We are, maybe for some people who are newer to the field, very excited that actually very early in the game after FDA approval, NCCN, which is the voice of oncologists, the experts in the field, have included Shield as a modality for colorectal cancer screening. They are typically laggers, but they decided to take this action much earlier than what we expected. We didn’t expect to hear from NCCN anytime soon. I think that’s an endorsement of something that just even common sense you should believe in, which 75% of colorectal cancer mortality is coming from the patients who are unscreened or they are not up to date with cancer, 50 million people. As long as you detect colorectal cancer at stage 2, you can cure or offer very long-term survival to the patient as long as you detect them at stage 2.

We have a blood test that can detect these cancers with very, very high performance. What do you think the guidelines should do? Common sense is unscreened patients should get this blood test at least instead of remaining unscreened. I think this just endorses this common sense and belief and confidence that we have that guidelines would recommend Shield for screening of cancers for colorectal cancer.

Kalam Tichumas, Life Sciences team, Morgan Stanley: Great. Just on the commercial team, I think the plan is north of 250 reps by year-end. How are you thinking about that ramp, you know, to reach full productivity for the reps themselves? How long does that typically take?

Helmy Eltoukhy, Chairman, Co-Founder, and Co-CEO, Guardant Health: We are building that infrastructure as quickly as we can. We are on track to end the year with more than 250 sales reps promoting Shield in different PCP accounts. The productivity that we are seeing in our recently hired reps is better than what we originally expected. That is contributing to the fact that the initial ramp is going faster than what we internally forecasted. In general, in diagnostics, you expect after six to nine months, the reps to generate some material contribution. It takes them 12 to 18 months to get to a better part of their ESCARE. The tenure of our reps in the field is on average about nine months right now. We are still going through that growth of productivity.

Kalam Tichumas, Life Sciences team, Morgan Stanley: On the commercial coverage side, maybe talk about some of the efforts there to broaden that. Any color as well on ASPs would be appreciated.

Helmy Eltoukhy, Chairman, Co-Founder, and Co-CEO, Guardant Health: Maybe I start with coverage, and Mike, if you want to talk about ASP, please. Guideline inclusion is a catalyst for commercial payer. After NCCN, we started accelerating some of our conversation with other commercial payers to broaden access for Shield to younger patients. Right now, Shield is covered by Medicare and VA. About roughly 60 million people out of 120 million people have access to Shield in terms of their coverage policy. The rest is going to get opened up after American Cancer Society guidelines and USPSTF includes Shield in their guidelines. We are not counting on any commercial coverage till we get to really ACS and USPSTF guidelines.

Kalam Tichumas, Life Sciences team, Morgan Stanley: Yeah, maybe to add on ASPs, I mean, we’ve seen since launch really good, really good traction on ASPs. Of course, we got the ADLT rate that went into effect on April 1, 2024. That increased our Medicare rate from $9.20 to $14.95. Since then, we’ve seen really good pull-through on Medicare Advantage. A lot of the Medicare Advantage payers now have quickly fallen into line and are paying us at that Medicare rate as well. Our focus at the moment has been very much heavily weighted towards Medicare Advantage patients. I think that’s set us up with a really good ASP. I think going forward, obviously, our aims will be when we do get to coverage from commercial payers to keep a high ASP. We want to be targeting that $14.95. As AmirAli said, it’ll take time for that commercial payment to come through.

Yeah, we’re really pleased with where the ASPs are today. Great. Maybe shifting to therapy selection, before we dive deeper, just give us a sense of where the market is today. You know, what % of patients are getting no testing versus hospital testing versus CGP?

Helmy Eltoukhy, Chairman, Co-Founder, and Co-CEO, Guardant Health: Yeah, I think the estimates vary. You could say maybe tissue market is about 50% penetrated with some kind of panel testing. Some of them may be smaller panels. Maybe 30% on the liquid side. That’s really for one test per patient per lifetime.

Kalam Tichumas, Life Sciences team, Morgan Stanley: You’re guiding to, I think, north of 27% volume growth for oncology. Guardant360 has been around for a number of years now. How are you still able to outpace the market here?

Helmy Eltoukhy, Chairman, Co-Founder, and Co-CEO, Guardant Health: I think it’s really a testament to innovation that we’ve had. About a year ago, we really did the first of this major upgrade to smart liquid biopsy. That has really accelerated the growth on the Guardant360 side of the picture. It’s because we’re providing so much more utility, I think, than what exists out there per test. That utility is only growing. We added 11 more applications under that framework, under that test just a few months ago. That’s really resonating with the field very well. There’s a lot of excitement there. It really is sort of capturing the enthusiasm we first saw when we launched Guardant360 maybe 10 years ago. We’re seeing that same kind of excitement in terms of all of the new capabilities of this platform. The nice thing about it is this is truly a platform.

We’ve now completed the upgrade of our entire portfolio to smart liquid biopsy with Reveal last year and now Tissue just a few months ago. The nice thing about that is that essentially, this framework allows us to plug and play these apps into each of those tests, so that there’s a common design language, common framework, sort of common utility, shared utility between these tests. We really haven’t turned on that sort of synergistic framework yet. As we turn that on, we think that’ll further catalyze adoption of our portfolio.

Kalam Tichumas, Life Sciences team, Morgan Stanley: You recently highlighted the launch of 11 smart liquid biopsy applications for Guardant360 Liquid. Please provide a high-level overview of the applications launched so far. Investors, I think, want to know when that starts comparing to the top line.

Helmy Eltoukhy, Chairman, Co-Founder, and Co-CEO, Guardant Health: Yeah, look, I mean, we’re already seeing traction with those apps. It’s one of the most talked-about aspects of our launch. I was at ASCO in June, just a couple of weeks after we launched them. I can tell you the enthusiasm there was at a very high level. In terms of applications, we can now essentially see tumor biology in blood. We can essentially define the histology of disease. We can do what was once only the realm of tissue slides and H&E and IHC and so on in blood to a large extent, almost redefining and, frankly, defining in higher resolution the underlying biology of a patient’s disease. What does that mean?

That means we can see things that were even very difficult to capture in tissue, like histological changes in disease under therapeutic pressure, patients who had non-small cell lung cancer shifting towards small cell lung cancer, which really has implications around essentially changing therapy and so on that were undetected before Guardant360. We can see other changes. I think some of the new apps that are in the roadmap, we have something like 50 apps that are under development that still will be launching once they’re validated. We’re going to be able to predict essentially response to major classes of therapies as well in a way that’s far better than the current approaches. It’s going to blow stuff like tumor mutational burden out of the water in terms of precision and the ability to really find those patients who can benefit.

We can see things where typically you have drugs that are targeted therapies that essentially find most of the patients with those targeted therapies, but there always tends to be some responders outside of that class. We can actually find those responders that may not have an oncogenic mutation but may still be candidates for that therapy. It’s really exciting what we can do with this platform. I think you saw in our pharma business, the year before, we had this major step up in our pharma volumes, major step up in the number of pharma companies that are working with us. That is kind of what they were seeing maybe a year earlier than the clinical markets.

Kalam Tichumas, Life Sciences team, Morgan Stanley: Mike, maybe back to you on ASPs for Guardant360. I think now between the $3,000 to $3,100 range. Talk us through what’s needed to get that higher and maybe some targets two, three years out.

Mike Bell, CFO, Guardant Health: Yeah, you know, I mean, if I think back to our investor day two years ago, we set a target of $3,000 by 2028. We’ve, you know, we’re already ahead of that with this $3,000, $3,100. What’s really driven that was that at the start of 2024, we got an increased Medicare rate to $5,000. Both the CDx version and the LDT version of Guardant360 Liquid are now at $5,000. The team’s done a fantastic job of pulling through the Medicare Advantage payments as well. Effectively, we’re getting very, very high payments on there from Medicare Advantage paid. Where we still got opportunity to increase is really on the commercial side and expanding the coverage. We’ve got very good coverage now over 300 million lives, primarily focused on lung and breast. I think for other indications, that’s where our opportunity is.

We’re really focused on, you know, the large national payers and expanding the coverage and contracting where it makes sense. We think, you know, over the next couple of years, that range can now go up maybe another 10%, you know, $3,200, $3,300. We feel pretty confident that we’ve got a good pathway together.

Kalam Tichumas, Life Sciences team, Morgan Stanley: Fantastic. Serena Six, I think you’ve described that as conferring an MRD-like opportunity for Guardant360, potentially doubling your breast cancer volumes. What’s the testing frequency per patient today? What could that number go to as a result of Kamu’s Estrone approval?

Helmy Eltoukhy, Chairman, Co-Founder, and Co-CEO, Guardant Health: Yeah, right now, this is, I think, the exciting part of sort of leading in liquid on the therapy selection side is that, you know, we see a future where it’s not just one test per patient per lifetime, but patients should be tested, you know, obviously at diagnosis, at every progression. They should be tested in terms of monitoring response, you know, in between. You can imagine, you know, a world where patients are getting tested three or four times per year and a world where the drugs are essentially allowing patients to live much longer, their second, third, fourth line therapies. Right now, we’re just at the very beginning of that new paradigm. We’re still, I think, you know, around 1.2, 1.3 tests per patient when you think about Guardant360. We’re still very much at the early innings there.

It’s inching up as patients are being tested at progression. I think catalysts like ESR1, you know, if that gets approved for Kamu’s Estrone, I think that will usher in much more quickly that new paradigm of testing early, testing often, and essentially treating molecular progression of disease, which is ultimately where we believe all of advanced and even early-stage oncology will be going.

Kalam Tichumas, Life Sciences team, Morgan Stanley: Any other cancer types that you’d call out for that similar?

Helmy Eltoukhy, Chairman, Co-Founder, and Co-CEO, Guardant Health: Yeah, there’s a similar paradigm with AR resistance in prostate cancer as well. There’s a few others as well. This is not one and done. This is just the beginning of, I think, a tip of the spear in terms of really sort of a new era of monitoring disease, switching rapidly as you see emerging clones and emerging genotypes in patients.

Kalam Tichumas, Life Sciences team, Morgan Stanley: OK, moving across the portfolio on the MRD side, how would you describe physician willingness to try a tumor-naive approach once they already have a bunch of patients on Signatera? Is that a gating factor at all?

Helmy Eltoukhy, Chairman, Co-Founder, and Co-CEO, Guardant Health: No, I mean, I would say there’s a huge need for a tissue-free approach in the market right now. Depending on the cancer type, and the new adjuvant setting as well, which is increasingly becoming the standard of care, there is a lack of tissue for a large swath of patients. Anywhere from 10% to 40% of patients may not have adequate tissue for a tumor-informed approach in that early-stage setting. Furthermore, when you think about essentially the fact that this market of 15 to 18 million cancer survivors, 12 million of them are more than five years out from surgery, where that initial tissue that was taken or the surgical specimen that was taken may not truly still be representative of the disease that emerges three years later, four years later, or five years later.

That’s where I think a tissue-free approach with a wider catchment to be able to detect secondary primaries and other similar disease that may be emerging there is extremely important. I do believe that right now the market, just like with tissue CGP, may have started with tumor-informed, but that ultimately the larger market will be tissue-free over time as those applications become more and more commonplace.

Kalam Tichumas, Life Sciences team, Morgan Stanley: How long do you think that will take? 10 years from now, what do you think the market looks like?

Helmy Eltoukhy, Chairman, Co-Founder, and Co-CEO, Guardant Health: I think 10 years from now, I would be very surprised if tissue-free is not more than half the market opportunity or actually realized in the market. Just, you know, look at where liquid is today in the CGP side. We launched Guardant360 in 2014, and now you can see we’re fairly dominant in terms of volumes, in terms of the, you know, we’re testing at least in breast and lung and colorectal, probably approaching 25% of all advanced cancer patients. That is, I think, a similar dynamic we see playing out on the MRD side.

Kalam Tichumas, Life Sciences team, Morgan Stanley: Mike, just on the Reveal ASPs, I think now just sitting over the $600 following Medicare coverage, what are the key drivers to achieve that $1,000 target by 2028?

Mike Bell, CFO, Guardant Health: Yeah, I mean, really, the key drivers in the short term is going to be breast reimbursement. We’ve submitted to MolDX. We would expect to get that, you know, by the end of the year, early next year. We’ve also submitted to MolDX for IO. You know, getting both of those will have a nice step up. We’ve seen some traction with commercial payers. It’s still, you know, the commercial element of our overall, you know, $600 to $700 ASP, the commercial element is still relatively small. It is increasing. You know, we have a team that’s really focused on expanding their commercial coverage. I think, you know, we feel confident with those steps that can get us to the $1,000.

Kalam Tichumas, Life Sciences team, Morgan Stanley: What percent of Reveal volumes come from breast today?

Mike Bell, CFO, Guardant Health: If we break that out, CRC is about 50% of the volume, and then next is breast, followed by lung.

Kalam Tichumas, Life Sciences team, Morgan Stanley: You mentioned Reveal is currently tracking around 1.7 tests per patient. You have market comms at 4 to 5, I believe, per patient. Which initiatives are you implementing to increase that metric, and what timelines would you put to close that gap?

Helmy Eltoukhy, Chairman, Co-Founder, and Co-CEO, Guardant Health: Yeah, no, we’ve improved over the 1.7 now with some of the operational machinery we’ve put into place. A lot of it has to do with logistics around pulling subsequent draws, subsequent orders from those patients. It’s things like offsite phlebotomy, nudges on the portal, being able to essentially prod and prompt both the physicians and patients that there’s another test due. We’ve had good success with those measures so far, and we see that continuing to convert orders into volume over time.

Kalam Tichumas, Life Sciences team, Morgan Stanley: How did the Medicare CRC surveillance coverage impact patient stocks, and I guess, repeat test frequency as well?

Helmy Eltoukhy, Chairman, Co-Founder, and Co-CEO, Guardant Health: Everything’s been going up since we got that. We’ve been very pleased with the, you know, kind of the awareness and the sort of push that was made possible with that coverage.

Kalam Tichumas, Life Sciences team, Morgan Stanley: I guess beyond what we’ve discussed, CRC, breast cancer, IO monitoring, which other cancer types are in the reimbursement pipeline? How do you prioritize which indications to pursue next?

Helmy Eltoukhy, Chairman, Co-Founder, and Co-CEO, Guardant Health: A lot of it is dictated on maturity of the cohorts that we have for other indications. I think we talked about a couple of years ago, I think we have like something like 12 to 15 tumor types that we’re working on in terms of cohorts and samples and testing. I can tell you that we’re making a lot of progress with those tumor types. Hopefully, we’ll be able to update everyone around some of that progress soon.

Kalam Tichumas, Life Sciences team, Morgan Stanley: Which smart liquid biopsy capabilities are you planning to incorporate into Reveal just to further differentiate that offering?

Helmy Eltoukhy, Chairman, Co-Founder, and Co-CEO, Guardant Health: Yeah, I mean, I think some of the exciting things are the ability to essentially monitor toxicity of drugs. When you think about some of these drugs, unfortunately, they have high liver toxicity, cardiotoxicity, other organ issues. I think when we think about where Reveal is going, we see a test that right now people are doing these apples-to-apples comparison in terms of just detecting tumor burden and sensitivity and specificity. We believe that Reveal could eventually become a test that is much more holistic in terms of really monitoring the health of the patient in a much more complete way. It really becomes a sort of different kind of test than exists in the market today. The nice thing about how Reveal works is that it is very synergistic because it’s built on the same railroad tracks as Guardant360.

When someone has a positive test, we can easily essentially cascade them to a Guardant360 test and vice versa. They work very nicely with one another.

Kalam Tichumas, Life Sciences team, Morgan Stanley: It’s gross margin positive Reveal for the first time. What are the plans to further reduce costs while scaling volume, and what’s a reasonable kind of mid-term two, three-year target for the gross margin there?

Mike Bell, CFO, Guardant Health: For Reveal, yeah, I mean, we’ve made significant progress in the cost of goods sold over the last 12 months now. A year ago, cost per test was over $1,000. Now it’s under $500. That’s been driven really by workflow improvements, reducing the sequencing cost quite dramatically. I think two things going forward can really help Reveal. One is going to be volume. I think, yes, volume continues to ramp up. That’s going to have an impact. Secondly, automation. It’s something we talk about a lot with Shield. We’re investing heavily in automation with Shield. We’ve got a very experienced team who’ve built large volume, large-scale labs in the past with automation. We’re planning to put that in place first with Shield, but then that automation is easily transportable to Reveal. I think that can also drive down.

Our longer sort of 2028 targets for Reveal cost of goods sold are $400 per test. We feel confident that we can at least get to that, if not further lower the cost. That would mean if we’ve got a $1,000 average selling price in 2028 and $400 cost of goods sold, of course, 60% gross margin. We feel we’re well on track both on the average selling price side and the cost per test side to get to that 60%.

Kalam Tichumas, Life Sciences team, Morgan Stanley: Obviously, strong across the board, you know, strong oncology growth this year expected to hit that 20% mark. How sustainable is that revenue growth as we look to 2026 and beyond? Again, high level, you can hit it however you want.

Helmy Eltoukhy, Chairman, Co-Founder, and Co-CEO, Guardant Health: Yeah, I mean, we feel, I think we’ve talked about a lot of the drivers. I mean, ASP, we think we’ve got ASP upside from where we are now across the portfolio. We’ve not talked much about tissue. I think, you know, again, that we’ve reached a $2,000 ASP. We think there’s a lot more room and a lot, you know, additional increase that we can get on that ASP. I think across Guardant360 Liquid, tissue on Reveal, ASP is going to be one of those drivers. Again, you know, with smart liquid biopsy, with the opportunity for monitoring with Guardant360 Liquid, I think with tissue, you know, with an upgraded test now, with a best-in-class test, and still a relatively small market share, we feel we’ve got a lot of opportunity ahead of us to grow that. I think, again, we talked about Reveal.

We think it’s still early days, indication expansion, and just driving the commercial execution on Reveal. You know, we feel we’re well set up for continued growth over the long term with the oncology business.

Kalam Tichumas, Life Sciences team, Morgan Stanley: I didn’t want to ignore the biopharma and data business. I think you raised expectations there as well. Maybe just give us the overview of what you’re seeing and how sustainable you think those levels of growth are.

Helmy Eltoukhy, Chairman, Co-Founder, and Co-CEO, Guardant Health: Yeah, it’s been really exciting to see a lot of our partnerships with the biopharma companies we’ve been working with really grow into more of a strategic sort of nature, where we’re working not just with single programs, but working across a large swath of their development and research portfolio and really helping with optimization of some of the assets in their portfolio in terms of scaling certain arms or failing certain arms. A lot of it has to do with the fact that liquid is just so easy to basically use to both characterize patient disease, monitor patient disease, monitor whether the drugs are working.

I think even more excitingly is really the smart liquid biopsy aspect, the epigenetics aspect, which is allowing us to essentially and allowing them to view the disease with an entirely different lens that allows them to give sort of a little bit more ability to kind of decide, is this drug really working? How is it working? Really understand the functionality and mechanism of action of some of these therapies. That has been really exciting. I think we’re just at the really early innings of using that technology to its fullest with biopharma. The other sort of driver has been the international aspect of biopharma. The China business has been very strong for us. I think we’ll continue to be a nice sort of driver of business in the coming years.

Kalam Tichumas, Life Sciences team, Morgan Stanley: How do you think about that trade-off between investing for growth, but also wanting to scale a profitable cash-generative company? This isn’t a new story. Still waiting for that consistent operating profitability. Just talk us through how we should be expecting the next few years to play out and when we can start seeing that consistent cash generation come through.

Mike Bell, CFO, Guardant Health: Yeah, I mean, it’s obviously something we’re very focused on. It’s definitely a balancing act on reinvesting for growth as well as driving to profitability. You know, we set a target of by the end of 2028 to be cash flow break even across the whole company. I think we’re making really good strides to get there. If you look at the business excluding screening, we’re closing in on being cash flow break even. We expect to be there. We’re very confident we’ll be there by the end of this year. Following that, you know, that business excluding screening again is going to start to generate positive cash flow. We want a lot of that incremental gross profit to be dropping down to the bottom line. Screening is a little bit different. We’re in an expansion phase at the moment.

We’re reinvesting all of that incremental gross profit into the commercial build-out. That’s going to take a couple of years. We’re going as fast as we can. We expect similarly in 2026, we’ll have a similar level of burn. I think we expect by 2027, when we’ve built out that commercial infrastructure to such a level of scale, then we’ll see an inflection point. We’ll start to see the burn on screening rapidly come down. Yeah, we’ve sat here really pleased with how the business is performing and feeling very confident to get to that break even, at least by the end of 2028.

Kalam Tichumas, Life Sciences team, Morgan Stanley: Great. One more, and we’ve got to be quick. What’s something you wish investors paid more attention to or asked you more about? I’ll leave that open to anyone.

Helmy Eltoukhy, Chairman, Co-Founder, and Co-CEO, Guardant Health: I think it’s really like looking at where the puck is headed in all of our businesses. You know, we think about liquid CGP, going from one test, maybe per lifetime to multiple tests. Same thing in terms of MRD, where the puck is going to be in terms of a huge opportunity around tissue-free. Certainly in screening, when we think about going from single cancer to multi-cancer to maybe even more with this amazing vehicle we have called Shield. I think as exciting as the present is, the future is probably 10 times more exciting in terms of where we can go with this platform.

Kalam Tichumas, Life Sciences team, Morgan Stanley: Great. Helmy, AmirAli, Mike, thank you so much.

Helmy Eltoukhy, Chairman, Co-Founder, and Co-CEO, Guardant Health: Yeah, thank you.

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