Guardant Health at TD Cowen Conference: Strategic Growth and Challenges

Guardant Health (NASDAQ: GH) presented a robust outlook at the TD Cowen 45th Annual Healthcare Conference on Tuesday, 04 March 2025. CEO Helmut Otooke and CFO Mike Bell highlighted the company’s strategic initiatives, focusing on the promising potential of their Smart Liquid Biopsy platform and the expansion of their CRC screening business. While Guardant Health is positioned for growth, challenges such as new sales rep productivity and potential competition remain.

Key Takeaways

• Guardant Health aims for breakeven by 2028, supported by a strong cash position and strategic debt restructuring.
• The Smart Liquid Biopsy platform is expected to drive significant growth in G360 volumes and market share.
• The company anticipates the launch of a new tissue test and expansion in the MRD market.
• Shield’s FDA approval and Medicare coverage are pivotal for expanding the CRC screening business.
• The potential inclusion of Shield in ACS guidelines could boost screening volumes.

Financial Results

• Cash reserves stand at approximately $900 million, with a projected burn of $450 million to $550 million by 2028.
• Convertible debt has been restructured, with $600 million extended to 2031.
• The core CGP business was profitable in 2024 and is expected to increase profitability in 2025.
• The MRD business, which burned $100 million in 2024, is expected to see reduced costs and increased profitability.

Operational Updates

• The Smart Liquid Biopsy platform is set to enhance G360 volumes and market penetration.
• The launch of a new tissue test is planned, leveraging the smart platform for better clinical utility.
• The sales force in the screening division is expanding, with 150 reps expected by year-end.
• New sales reps require six months to reach full productivity, posing a short-term challenge.

Future Outlook

• Guardant Health targets breakeven by 2028, with a focus on increasing Shield test volumes to 45,000 to 50,000 in 2025.
• The company expects to receive ADLT status for Shield, enhancing Medicare reimbursement rates.
• Expansion plans include targeting the MRD market and multi-cancer testing opportunities.
• Potential challenges include securing ADLT status for MRD and staying ahead of competitors.

Q&A Highlights

• The Smart Liquid Biopsy platform offers detailed subtyping and classification of cancer.
• Guardant Health is addressing convertible debt with various options to ensure financial stability.
• The company is aggressively targeting the surveillance population with its MRD test.
• There is potential upside to screening volumes if ACS guidelines include Shield.

Guardant Health’s detailed strategies and financial plans were thoroughly discussed during the conference. For more information, please refer to the full transcript below.

Full transcript - TD Cowen 45th Annual Healthcare Conference:

Dan Brennan, Analyst, TD Cowen: day two of the TD Cowen Global Healthcare Conference. I’m Dan Brennan. I follow Tools and Diagnostics. Really pleased to be joined with me on the stage here, our senior management team of Guardant Health.

We have to my right, Mike Bell, Chief Financial Officer, and to his right, we have Helmut Otooke, who’s the CEO. Gentlemen, thanks for coming. Thank you. So a lot to be excited about for Gordon, after a really strong finish to 2024. You have acceleration in g three sixty volumes, momentum in MRD business, after recent approvals, and you’ve got cost reduction.

And now you’ve got the CRC screening business, really, you know, picking up scene here. So maybe I would just like to start off, maybe, Helmi, you can kick it off, kind of maybe look back on ’24 and, you know, talk a little bit about, you know, what excites you most heading into ’25.

Helmut Otooke, CEO, Guardant Health: Yeah. No. I mean, I think we have a really fantastic setup, in terms of all the work that we’ve done in ’24, in terms of what we have to look forward for in ’25. If you think about all the work we did in terms of setting up, EMR integrations, the product upgrade cycle in terms of moving our oncology portfolio onto Smart Liquid Biopsy onto this new platform. You know, some of the progress we made with biopharma in terms of getting them onto Infiniti and Smart Liquid Biopsy and some of the big deals that we signed.

And then obviously all the work we’ve done in terms of FDA approval for Shield, getting first line indication, getting Medicare coverage at a fantastic rate, I think really sets things up really well for ’25. And then obviously, the beginning of the year has been fantastic as well in terms of getting surveillance coverage for REVEAL. And then, you know, I think we’re excited about the potential for what this, Sirena six readout means for where three sixty can go in the future.

Dan Brennan, Analyst, TD Cowen: Terrific. Maybe starting with SmartLoquine Biopsy, staying at a high level, it’s kind of the centerpiece of your offerings and strategy. You know, while you talk about it a lot, I think investors are still, you know, trying to incorporate it to impact per se into a model, you know, isn’t easy. So, you know, you call out better insights that your approach delivered for sort of players. So could you just break down the benefits of small liquid biopsy, maybe starting with G360 in clinical applications and then moving over to the pharma business and what kind of impact could it have on your P and L?

Helmut Otooke, CEO, Guardant Health: Yeah. No. It’s, it’s fundamentally, essentially a different lens into the patient’s disease, really looking beyond the sort of genomic markers that are there and really looking into essentially the biological underpinnings of each patient’s cancer. And so we’re gonna be able to essentially subtype and classify disease at much greater resolution than was possible. I mean, if you think about genomic I’ll give you an example.

Like, there are patients that are positive, let’s say, for a KRAS, you know, G12C, but you see very different response rates between those patients. Some, you know, that respond really well and others that don’t respond at all. When you look at it through an epigenetic lens, you can see these essentially clusters of patients that essentially have different disease, but they just harbor the same mutation. So that is, like, I think, why you’re seeing the big traction with biopharma last year and sort of a leading indicator and where things are going, where, I think it’s gonna look like, essentially what people are doing with comprehensive genomic profiling before, you know, is going to look like black and white television versus four ks TV in terms of where we’re going, in terms of the resolution and ability to actually diagnose disease, subtype disease, and then decide what tools to use. I can tell you already, like, what’s out there has been resonating with the field.

I think you’ve seen acceleration in terms of our volumes last year. We’re off to an amazing start this year. And so you see, essentially what’s there already, like things like promoter methylation. You see many trials out there, promoter methylation of MGMT, there are other, genes that, you know, if they’re methylated, indicate meaningful change in clinical decision making today. And that’s, you know, on the test already, it’s been resonating.

But all these other features we’re talking about in terms of subtyping disease, you know, understanding toxicity of drugs, we can actually see those patients that, may be undergoing cardiotoxicity, liver toxicity. All of that will be sort of new information that will make essentially the oncologist job a lot easier in terms of, you know, correctly caring for their patients.

Dan Brennan, Analyst, TD Cowen: And can the other kind of leading CGP players, can they catch up? Can they, you know, add methylation and, you know, epigenetic markers? Or kind of how do you view your level of differentiation today and, you know, kind of how durable is that?

Helmut Otooke, CEO, Guardant Health: So, I mean, of course, I mean, we don’t take anything for granted, in terms of, you know, the the competitive landscape. That being said, we think the bar is a little bit higher on smart liquid biopsy just because the chemistry is a lot more challenging in terms of it’s not just getting it to work, but it’s getting it to work at scale. And obviously, we have an FDA approval on the shield side, you know, behind us. We have, you know, years and years of operations in terms of getting that, you know, to the finish line. But I would say that, the other piece that’s a little bit more unique about this than a genomic marker, you know, sure, you know, when you think about detecting an EGFR mutation, you don’t need a lot of data to be able to do that.

You just need analytical validation. You can do that with, you know, a few hundred samples. A lot of what a lot of what we’re classifying needs thousands and tens of thousands of samples to be able to sort of, you know, classify, the biology that’s there and to make sure that, you know, the the correlations we’re making are sound. And that’s a lot of the legwork we’ve been doing over the last few years is is literally, you know, now approaching a hundred thousand samples that have been used for training in terms of these algorithms, these subtyping algorithms, these, you know, toxicity algorithms and so on. So there is a data moat that is required to be able to turn this on and get the kind of performance we’re seeing.

Interesting. So maybe Mike,

Dan Brennan, Analyst, TD Cowen: Garden Ridge recently completed some action to address and extend the converts. You know, pro form a capital structure, you have, I think, $890,000,000 in cash, $1,100,000,000 in debt and $400,000,000 4 90 million dollars in converts due in 2027. Just speak to, maybe what are the next steps? Do you guys feel good where you are today in terms of the remaining converts? Like how

Mike Bell, CFO, Guardant Health: do you handle those? Yes, Dan, I would say, I mean, firstly, we feel very comfortable with where we are today with the balance sheet. Yeah, we restructured our convertible debt. We pushed 600,000,000 of that debt out to a maturity of 02/1931, so quite a long way in the future. And we’ve got $490,000,000 left that matures in towards the end of twenty twenty seven, so still almost three years.

And cash position, you mentioned it, of around 900,000,000. So I think, firstly, from a cash perspective, that’s more than enough to get us to breakeven. We said we’ll be breakeven in 2028 at the latest. And between now and then, we would burn something like $450,000,000 to $550,000,000. So the sort of 900,000,000 that we have cash today is sufficient to get us there.

I think the focus next probably will be on the remaining convertible. Again, it’s still almost three years from maturity. It’s 0% coupon. So we feel we’ve got time to address that and we’ve got a lot of optionality. So I think, yes, we’re feeling very comfortable with how the balance sheet stretches at the moment.

Okay.

Dan Brennan, Analyst, TD Cowen: So maybe digging into clinical, you guided your clinical oncology volumes to accelerate in 2025% to 25% growth, up from 20% in twenty twenty four percent. I think it’s a mix of G360 and also MRD gaining momentum here. So, could you speak kind of unpack the assumptions towards that accelerating volume growth?

Helmut Otooke, CEO, Guardant Health: Yeah. Look, you know, I think a big driver on the G360 side is this upgrade to the smart liquid biopsy, this transition that we’ve made. And we have a lot of confidence there because we’ve already seen proof in the pudding in terms of volume acceleration late last year and good start to this year. And we know we have many other features still yet to come, which will further drive, I think, that switching away from other providers, from other tests, as well as deeper penetration into the market. With MRD, I think we know that the surveillance population is really sort of the prime target for a tissue free approach and really haven’t been going after that just because we haven’t been paid there.

And now that, you know, I think we have this surveillance reimbursement indication sort of behind us, we’re going aggressively towards that very, very large patient population. And it’s gonna take some time to get to those patients. But we think certainly this year we’re going to see that inflection and obviously we know we’ll have acceleration in that business over last year. And then I think the third component is the upcoming launch of our tissue test. We think moving tissue to sort of our smart platform is going to drive, I think, real acceleration in the tissue business.

I think it’s going to drive share gains in terms of the space because we’re going to have a test that can meaningfully provide more clinical utility than we believe other tests that are out there.

Dan Brennan, Analyst, TD Cowen: Terrific. Then we’ll dig into Amorti a little bit more. But you mentioned Serenasix earlier in the discussion, Helmi, just kind of wondering how investors should think about the opportunity there after AZ just announced the trial was successful. They had a PFS benefit, we’ll see as the trial matures. But just kinda talk through a little bit of how we size that opportunity, like, how this compares to the OSEDRU initial approval, which were a nice lift in your g three sixty volumes when that came through.

But I know this one is different in terms of, I believe, the the the ctDNA is more of a primary readout as opposed to, I think, you needed to confirm with a scan with a Cedric. So just kinda talk to the opportunity and how we think about the potential impact.

Helmut Otooke, CEO, Guardant Health: Yeah. No. This is huge for this space. It’s it’s a it’s a true paradigm shift in terms of, essentially like treatment selection, in terms of, you know, how patients are adaptively monitored in terms of their therapy. And you can think of this as almost like the first sort of monitoring CDX or even first MRD CDX in some ways because what you’re doing is you’re essentially testing these patients every three months and looking for the emergence of the first sign of an ESR one mutation.

And, you know, that’s very exciting in the sense that, and I think I think the fact that you’re initiating a new drug regimen so early in the progression of that patient is probably one of the reasons that the results have been, you know, very positive. And so we think this not only, is it dawning of a new paradigm in terms of this molecular monitoring of patients in the therapy selection space. What it does is it sort of confers an MRD like sort of business or, you know, growth in terms of testing volume to the therapy selection space. And so we think, you know, this is really the tip of the spear in terms of what therapy selection will look like in the coming years. And there is a model of this, you know, in the heme space with multiple myeloma with, you know, many other diseases.

You’re switching therapies to the second line, third line, fourth line, as soon as there’s a molecular progression. And, And we think, you know, breast is just the first of many indications where this is potentially going to be a new paradigm. If you think about sizing the opportunity, with ESR1, that was a big lift for us. We saw more than a doubling of our breast business, very, very quickly within months of that approval. And if you think about what this means, this means that each of those patients are gonna have not just one test for ASR one, but multiple tests.

And so at least, you know, it’s it’s a, you know, it’s a multiple in terms of the opportunity of of the initial ASR one approval. I mean, they didn’t put

Dan Brennan, Analyst, TD Cowen: in their press release that there are two hundred thousand plus women with HR positive women treated with the medicine in the first line. So I’m just wondering and also, you know, catching up with some doctors, it sounds like these mutations can develop after years on therapy. So you’re talking three three tests a year for years. So any any way I mean, is that two hundred thousand the right kind of size or or is it much smaller than any any any other numerical kind of anchors to think about? Yeah.

It’s in

Helmut Otooke, CEO, Guardant Health: that ballpark. It’s, you know, between probably one hundred and twenty thousand to two hundred thousand in terms of, so it’s it’s it’s most of breast cancer. It’s something like seventy to eighty percent of breast cancer patients. So it’s a big opportunity.

Dan Brennan, Analyst, TD Cowen: And timing wise, would this, like, would you start to see it now? Would it would it take time until full results are reported out? And just kind of how do we think about the potential impact?

Helmut Otooke, CEO, Guardant Health: Yeah. That’s gated by the drug. I mean, it’ll have to get approved. Obviously, this is just an interim readout. And so, yeah, we think it’s something that could take shape, you know, probably second half of this year most likely.

Dan Brennan, Analyst, TD Cowen: Okay. So the CGP business was cash flow positive in 2024. I think you’re guiding to burn ex screening of $25,000,000 to $35,000,000 this year with breakeven in the fourth quarter. Mhmm. So kind of what does it imply for the profitability in the base CGP business this year, and discuss maybe OpEx leverage going forward in that business?

Mike Bell, CFO, Guardant Health: Yes. Dan, I think you’re right. So the core business was profitable last year. It’s going to continue to be profitable in 2025. In fact, that will increase.

And yes, we said by the end of this year, the business excluding screening will be breakeven. And so that infers that, yes, CGP is improving. MRD, we burned something like 100,000,000 in MRD last year. With the COGS reduction that we put in place, the increase in the ASP, that burn is going to come down rapidly for MRD. And so that’s really what’s going to drive and allow us to get to that breakeven for the business excluding screening.

And I would say excluding screening, there’s a huge amount of operating leverage now that we can get out of the business. Our research and development line is going to stay flat. It’s a healthy line that allows us to do everything that we need to do over the next few years. Our G and A, again, will be relatively flat for that part of the business next year. And on the sales and marketing side, we built the infrastructure now to support both therapy selection and MRD.

And so that’s it will have a small increase this year, but a huge amount of leverage we can get across both CGP and MRD. And so I think, yes, we’re feeling really good about how that business now is driving to be profitable in 2026.

Dan Brennan, Analyst, TD Cowen: I know one of the or the largest play in MRD is really taking up their OpEx for this year to add more sales people feet on the street. You guys feel comfortable with the size of your sales force. Is there any initiative maybe to take advantage as MRD is ramping to put more salespeople out there? You guys feel good?

Helmut Otooke, CEO, Guardant Health: Yes. We’ve always had a methodology by which we basically split territories as soon as we see revenue at a certain amount. And so some of that sort of takes care of itself as we see ASPs going up, as we see revenue in territories going up. That’s just good hygiene for us to sort of split territories where it makes sense and keep adding sales reps. So it’ll happen sort of organically.

Dan Brennan, Analyst, TD Cowen: Okay. Maybe flipping over to screening, I think you completed a little over 6,000 chill tests in the fourth quarter to get between 50 to 100 reps of people in the field, but it might have been closer to 50. I think as you said, the majority of the ads happened late in the kind of really late in the quarter. So and I know the plan is just to have 150 reps by year end. So you’re potentially tripling, you know, the activity of the reps.

So maybe just talk through how you thought about the guide on screening. I think the guide is roughly 45,000 to 50,000. I think that’s the number of 6,000, despite the tripling of the sales force.

Mike Bell, CFO, Guardant Health: Yes. Yes, you’re right. I mean, we ended the year with 100 people in the field on screen, but a lot of those was a wave that came in towards the end of the year. So not really they’ve not got up to the full productivity. For the new reps, I think it takes at least sort of six months to really see that sort of productivity level.

And we’ll be adding additional sales reps to the year. So I think the 45,000 to 50,000, we feel very confident in. But yes, we feel it’s going to be sort of back end loaded this year because of the time it’s going to take to really build up that productivity level. I think we see potential for upsides on that volume. We’ve not baked in any upside from getting into ACS guidelines.

And we’ve been very, very sort of focused on the covered patient population, so patients 65. And if we get if and when we get ACS guideline inclusion, then in those states that sort of mandated to follow those guidelines, that’s going to open up the commercial patient opportunity for us. And then we can push very hard on the voyage in those states. So again, I think we feel comfortable with that 45,000 to 50,000. It’s going to take time to build into that with the productivity of the reps, but we feel it’s a good number and there’s potential for upside.

Dan Brennan, Analyst, TD Cowen: And how do you think about obviously first quarter ’6 thousand ’4 hundred tests, but as you build up now to this 45,000 to 50,000, If you drew a circle in terms of who the target or what do you assume the initial uptake is in the first year between patients that weren’t screened at all before, ones that would do a colonoscopy and ones that would do in Cologuard or maybe fit. I mean, I’m sure you’ve got some real good market intelligence on, you know, who are the first customers who are likely to use Shield. Just could you give us a sense on that? Yeah. I think,

Helmut Otooke, CEO, Guardant Health: you know, certainly, there’s a huge opportunity in the unscreened population right now, I think 50,000,000 Americans who are unscreened. And, you know, the good news is that physicians sort of know which ones of their patients, you know, are sort of due for screening, that have refused a colonoscopy, that have not complied with stool testing. And so there’s a lot of opportunity to hit the ground running just in that population. And then of course, you’re going to get some crossover in the other ones. But there’s just huge greenfield opportunity right now in that initial group.

Dan Brennan, Analyst, TD Cowen: So back to ACS, I think you talked about maybe 11 states or maybe you can remind us how many states are linked to ACS. If you get the ACS recommendation, do you just go after those specific states? Do you open up to the whole country? Just kind of walk through a little bit about expectations for ACS and then how you might use that to deploy the Salesforce?

Helmut Otooke, CEO, Guardant Health: Yeah. Look, I mean, we we have a strategy where we’re going after, you know, patients that have coverage. And, you know, obviously, ACS coming online will change the dynamics there positively for us. And we’re gonna be very aggressive in terms of, you know, where we see, you know, patients who could benefit from this, and who have coverage that’s there. So, yes, of course, we’re going to be targeting those dates when they come online.

Dan Brennan, Analyst, TD Cowen: And in terms of pricing, it’s obviously been a real positive for Shield with the gap fill rate and then the ADLT rate. Just kind of remind us on, I know you talked about it just recently on the call, but ADLT kind of getting that implemented like kind of what’s the outlook for that, Mike or help me?

Mike Bell, CFO, Guardant Health: Yes. No, I mean, again, we feel confident on getting ADLT status. It’s an FDA approved test. So we look at this as just an administrative process that we need to go through. We successfully got our PLA code.

That’s just a step in that. And so we’re it’s work in progress. We fully expect it in 2025. And yes, it will be an upside for us because our Medicare rate would go from $9.2 to $14.95 And so yes, we look at that very positively.

Dan Brennan, Analyst, TD Cowen: And maybe just in terms of kind of real world evidence on Shield, I mean compliance is a big lever for you in terms of how potentially that will help patients actually take the test. What are you going to be doing? I know when you had the FDA panel last year, I think there was some stipulation to have some follow-up activities. Just kind of walk us through as you’re launching this year, what kind of other clinical evidence you’re gathering in the real world and you know, how that potentially will, you know, be presented or influence, you know, the shield outlook?

Helmut Otooke, CEO, Guardant Health: Yeah. But I think I think we’ve already had a number of publications that we’re very excited about in terms of, showing that the adherence rate is well above ninety percent with a blood based modality. And so I think there should be no question that we can sort of drive real gains in terms of compliance and essentially health outcomes with a blood based modality. I think even, you know and that’s important and that work will keep, you know, ongoing, and we’re obviously doing some longer term studies to study that. But I think, you know, what’s what’s even more exciting in terms of is, you know, where blood based testing can go in the future.

I mean, obviously, CRC is not the only cancer we can detect in blood. And, you know, the current performance we have is, you know, not something we’re sort of, settled on. We always have a v two that, you know, potentially will will come out, you know, later this year. So I think the innovation engine is alive and well. And I think what blood based testing looks like now, will be very different than what it looks like in three years and five years as well.

And I think that’s what’s exciting is in terms of we have a really solid foundation in terms of what we’re building this, I think, new franchise on. And in

Dan Brennan, Analyst, TD Cowen: terms of multi cancer, I think you’re supposed to have some data this year just update us on what we’re gonna hear from Gardiner multi cancer?

Helmut Otooke, CEO, Guardant Health: Yeah. I think the findings of NCI will be presented in Q2 of this year. And I think that’s something that, you know, we’re also very excited about, the fact that, you know, I think somehow Shield was maybe pigeonholed as a CRC only test when in reality it was built, from the ground up as a multi cancer test, with CRC just being the first indication we turned on. And, you know, us now being part of the Vanguard study and being selected, among many other tests that were submitted there, I think it’s very exciting to see kind of what the future holds for these tests. And and that’s that’s the thing.

Like, you know, in a few years’ time, when you talk about, you know, these blood tests, if you’re only detecting CRC, you’re gonna be behind the ball. It was gonna have to be a multi cancer test with high performance to be able to essentially be something that is attractive to physicians in this country.

Dan Brennan, Analyst, TD Cowen: And is there anything in the guide for cash pay multi cancer? Like when would that actually begin to kind of come on the market? I know Exact is something in the guide this year on a cash pay basis. Just wondering how should investors think about the evolution of multi cancer impacting the income statement?

Helmut Otooke, CEO, Guardant Health: I think for us, we have the luxury of the fact that our business plan, you know, is is rational in the sense that, CRC is paying for the test and multicancer is a just a software over the air update on the same test essentially. And so marginal cost is, you know, is very low for us. And so, yeah, we have a lot of levers to think about that in terms of how the space evolves, whether the multi cancer bill passes or not. And so, which which I think almost every other multi cancer player doesn’t have that luxury because they don’t have a CRC indication. So on MRD, we’re gonna host

Dan Brennan, Analyst, TD Cowen: a panel tomorrow afternoon, and we’ll ask the doctors about, you know, kind of tumor informers, tumor agnostic and, you know, we think we’ve done some survey work as well. I’m just wondering, you kind of spoke about it earlier, Helmi. What type of like share opportunity do you think you have in, in CRC?

Helmut Otooke, CEO, Guardant Health: We have an enormous one. I mean, I think right now the market is is very focused on the sort of near term patients, the patient in the adjuvant setting, those that are one two years out from surgery. But when you look at the numbers, they’re enormous in terms of the prevalent population, twelve million that are five years out from surgery. Essentially, the majority of the the major cancer types when you think about breast cancer and colorectal and even prostate cancer, most of those patients are surviving, you know, for, you know, thankfully many years, and they’re worried about, you know, in terms of peace of mind, recurrence. And so a tissue free solution is gonna be the preferred modality in our minds to be addressing the needs of those patients.

And, you know, we’ve sort of been hamstrung a little bit because we haven’t had reimbursement in the surveillance setting in terms of really flexing sort of the muscle of this tissue free MRD test in that patient population. And that’s why I think this reimbursement, win has been really positive for us because it’ll really allow us to go after that big, big, population of patients that are out there that really don’t have anything, you know, that is that is meaningful for them to to be able to give them that peace of mind.

Dan Brennan, Analyst, TD Cowen: And is the idea there where if a patient starts an adjuvant, say, with tumor informed, that they would potentially go to agnostic? Or is it really that prevalence pool in agnostic that has never gotten an MRD test today that makes it much more appealing to do? We’re seeing both.

Helmut Otooke, CEO, Guardant Health: I mean, we’re seeing both. So basically, there’s a sense that, a year out, two years out, three years out, that a tumor informed solution may not be a wide enough catchment to essentially catch a cancer that, you know, for some reason didn’t rear its ugly head, you know, earlier. And so many people believe that there’s a secondary, primary. There’s, you know, other clones that may be there that were lurking in the background, maybe new incident disease in the same sort of tissue, system, that’s coming back. And that’s really where we see physicians actually preferring to use a tissue free modality eighteen months to two years out, even if the patient was on a sort of tumor informed modality.

And then obviously, there’s the wider sort of, you know, patient population of those that haven’t been screened, whatsoever. And then I think longer term, we see a lot of synergies with our therapy selection business and, you know, the screening business. The fact that, you know, right now when patients are positive with our MRD test, they can reflex automatically to a Guardant360. And so having that sort of nice ability for these tests to work together synergistically is a unique offering we have. And then over the longer term, you know, being able to use the primary care reps to go after primary care physicians that may have cancer survivors there and offer them an MRD test, I think, is gonna be really, really important.

Dan Brennan, Analyst, TD Cowen: Got it. We like little under a minute left. So I’ll do speed rounds. So ADLT for MRD, kind of what’s the conviction in getting that status?

Helmut Otooke, CEO, Guardant Health: Yeah. I mean, we absolutely believe, under the statute, we we qualify for it, you know, the first to hit, that sort of unmet need. It is subjective. So, you know, obviously, you know, it’s not a slam dunk like, you know, an FDA approval, but we think the chances are very good.

Dan Brennan, Analyst, TD Cowen: Got it. And, I guess, the final one which we asked most of the management teams, what what do you feel between all the different pieces of your business? What do you feel is maybe most misunderstood or investors aren’t kind of recognizing?

Helmut Otooke, CEO, Guardant Health: I think it’s hard to really truly quantify all the, like, different initiatives that we have. The sort of sum of the parts analysis, I think, doesn’t necessarily add up to, you know, the sum of the whole that we have here in the company. I think when you think about all the the excitement around MRD, excitement around Shield in terms of where that’s going, I think it’s still very much underappreciated. Great.

Dan Brennan, Analyst, TD Cowen: Well, thank you guys for being here. Thanks everyone in the audience. Thank you.

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