Guardant Health (NASDAQ:GH) reported second-quarter 2026 revenue of $335 million, up 44% from a year earlier, as growth accelerated across its oncology, biopharma and data, and screening businesses. The company also raised its full-year revenue outlook, citing demand for its Guardant360 and Shield offerings, new regulatory milestones and expanding reimbursement access.
Oncology revenue rose 38% year over year to $219 million, while oncology test volume increased 63% to about 104,000 tests. Guardant360 Liquid volume grew more than 30%, Guardant360 Tissue remained the company’s second-fastest-growing oncology product, and Reveal volume more than doubled as adoption expanded in minimal residual disease, or MRD, testing and therapy-response monitoring.
FDA approval and oncology portfolio expansion
The company began a phased U.S. rollout of Guardant360 Liquid CDx in June and expects broader availability following anticipated Advanced Diagnostic Laboratory Test, or ADLT, designation in the first half of 2027. CFO Michael Bell said the company expects an ADLT price of $8,455, compared with its current Medicare price of $5,000. He said it could take 12 to 24 months for Medicare Advantage and commercial payer pricing to adjust following an ADLT determination.
Guardant also highlighted its companion diagnostics business, which generated a record $61 million in biopharma and data revenue, up 9% year over year. The company now has 28 companion-diagnostic approvals, including four added during the first half of 2026. In the quarter, Guardant360 CDx received approvals as a companion diagnostic for Boehringer Ingelheim’s HERNEXEOS in HER2- or ERBB2-mutant advanced non-small cell lung cancer and for Arvinas and Pfizer’s VEPPANU in ER-positive, HER2-negative, ESR1-mutated advanced breast cancer.
The company also announced a collaboration with Nuvalent to develop companion diagnostics, initially focused on Guardant360 Tissue.
Reveal growth and reimbursement efforts
Guardant said Reveal remained its fastest-growing oncology product, with volume growth exceeding 100% year over year for the third consecutive quarter. The company attributed the momentum to MRD testing and the therapy-monitoring application launched in the prior quarter.
Management said therapy monitoring can help physicians assess treatment response before imaging and could represent a multimillion-test annual opportunity among late-stage cancer patients. The company has submitted data to MolDX seeking coverage for breast cancer surveillance, immuno-oncology monitoring and chemotherapy monitoring.
During the question-and-answer session, management said breast cancer and immuno-oncology reimbursement decisions appeared closest to completion and that it was hopeful for one or both decisions by year-end. Guardant also remains on track to launch Reveal Ultra later in 2026. Management said the tumor-informed MRD test has demonstrated limits of detection below one part per million in development, though it did not provide details on initial indications or commercialization plans.
Shield screening demand gains coverage support
Screening revenue increased to $53 million from $15 million a year earlier, driven by approximately 66,000 Shield tests, compared with roughly 16,000 tests in the prior-year quarter. Shield’s average selling price was approximately $800 per test, Bell said, with reimbursement remaining strong among Medicare fee-for-service and Medicare Advantage patients.
Co-CEO AmirAli Talasaz said Shield’s commercial momentum benefited from direct-to-consumer activity, expansion of Guardant’s field organization to more than 400 professionals, health-system outreach and its collaboration with Quest Diagnostics. He said the company added about 22,000 Shield tests sequentially from the first quarter but does not expect multiple new commercial initiatives to contribute at once in the third quarter.
Shield was added to the American Cancer Society’s colorectal cancer screening guidelines during the quarter, joining its prior inclusion in National Comprehensive Cancer Network guidelines. Talasaz said Shield is the only FDA-approved blood test included in both sets of guidelines.
UnitedHealth Group will begin covering Shield as a primary colorectal cancer screening option for average-risk adults ages 45 and older on Aug. 1. Management said the policy, combined with American Cancer Society guideline inclusion, means approximately 70 million lives, or about 60% of the eligible U.S. market, are now covered for Shield testing.
Talasaz said the company does not expect additional major commercial-payer coverage wins during the remainder of 2026 and has not included them in its outlook. He said the effect of UnitedHealth coverage on Shield pricing will take time to assess, including potential patient co-pays and collection history.
Cost reductions, outlook and cash flow target
Guardant received FDA approval for a higher-throughput, lower-cost Shield workflow that will enter production for new samples in August. Bell said the workflow, combined with further operating-scale efficiencies, is expected to reduce Shield cost per test by roughly 15% from the current level of about $410 by the end of 2026. The company continues to target a $200 Shield cost per test in 2028.
Second-quarter non-GAAP gross margin was 67%, compared with 66% a year earlier. Guardant completed its Guardant360 Liquid transition to NovaSeq X in May, which Bell said reduced cost per test by approximately $200.
Non-GAAP operating expenses rose 34% to $288 million, including sales and marketing expense of $172 million, as Guardant invested in screening commercialization and oncology growth. The adjusted EBITDA loss was $56 million, compared with a $52 million loss a year earlier. The company ended the quarter with approximately $1.2 billion in cash and investments and reported free cash flow burn of $70 million.
- Full-year 2026 revenue guidance was raised to $1.34 billion to $1.36 billion, representing 36% to 38% growth.
- Oncology revenue is expected to grow about 30%, with volume growth of about 50%.
- Shield revenue guidance increased to $218 million to $230 million, with expected volume of 270,000 to 285,000 tests.
- Full-year non-GAAP gross margin guidance remains 64% to 65%.
- Expected 2026 free cash flow burn increased by $10 million to $195 million to $205 million, reflecting accelerated investment in Shield laboratory capacity.
Bell said Guardant expects its business excluding screening to generate positive free cash flow in 2026. The company continues to target company-wide cash flow breakeven by the end of 2027, while saying higher Guardant360 pricing following a potential ADLT designation could accelerate that timeline.
About Guardant Health (NASDAQ:GH)
Guardant Health, Inc is a precision oncology company specializing in blood-based cancer diagnostics. Founded in 2012 and headquartered in Redwood City, California, the company develops non-invasive tests that use circulating tumor DNA (ctDNA) to profile genomic alterations in patients with solid tumors. Guardant Health’s mission is to advance cancer care by providing actionable data to clinicians, pharmaceutical partners and researchers worldwide.
The company’s flagship product, Guardant360, is a next-generation sequencing (NGS) assay designed to detect mutations, copy number variations and select fusions in more than 70 cancer-related genes.
