Sebastian Sandler

Sebastian Sandler asked about Caris Life Sciences' volume pacing expectations for 2026, specifically for tissue and blood, and whether growth would be higher in H1 versus H2. He also inquired about the impact of smaller sample sizes for some indications in the MSAT interim data on physician and patient comfort, and if Caris would consider offering a stand-alone breast test given its strong sensitivity.

Answer

Luke Power, CFO, clarified that tissue volume growth is expected in the low teens and blood in the high 50s, consistent with Q4 2025, with Q1 and Q3 typically lower due to seasonal factors, but confident in 20% overall year growth. David Spetzler, President, explained that smaller sample sizes for some cancers reflect the lack of effective screening, which Caris Detect aims to address. He stated that offering a stand-alone breast test would create an ethical quandary, as they would not want to withhold findings of other cancers.

Sebastian Sandler asked about Caris Life Sciences' volume pacing expectations for 2026, specifically if the company anticipates growing above the mid-teens for tissue and mid-thirties for blood in the first half, and then below in the back half, pending a ramp from new reps, and what the expectation is for Q1. He also inquired about the Caris Detect (MSAT) interim data, specifically if the smaller sample sizes for some indications would impact physician and patient comfort, and if a stand-alone breast test would be considered given the strong breast sensitivity.

Answer

Luke Power, CFO, clarified that the volume guide assumes low teens for tissue and high 50s for blood, consistent with Q4 2025, and that while Q1 and Q3 typically see lower volumes due to seasonality, the company is confident in the 20% overall year-over-year growth. David Spetzler, President, explained that smaller sample sizes for some indications are due to the lack of effective existing screening modalities, and these numbers will increase as Caris Detect finds early-stage cancers. He stated that a stand-alone breast test would create an ethical quandary, as the company would not want to withhold findings of other cancers.

Sebastian Sandler inquired about potential upside drivers for the clonoSEQ volume guide in 2026, specifically asking about community volume growth, NEO genomics contribution, guidelines, and incremental recurrence monitoring coverage. He also asked about the 2026 ASP guide of $1,400, its dependence on two called-out contracts, execution risk, and the pacing of ASP growth throughout the year.

Answer

Susan Bobulsky, Chief Commercial Officer of MRD, identified potential upside from EMR integration, particularly the pull-through on serial testing with Flatiron, and optimizing already integrated sites. She also pointed to continued focus on blood-based testing and community penetration. Chad Robins, CEO and Co-Founder, reiterated the five key drivers (blood-based testing, community, data readouts, guidelines, and EMR integrations) as areas of reinvestment and confidence. Kyle Piskel, CFO, and Chad Robins, CEO, expressed confidence in the ASP guide, noting multiple levers to achieve it despite some execution risk with key payer contracts, with pacing likely more weighted to the second half.

Sebastian Sandler asked about potential upside drivers for the clonoSEQ volume guide in the current year, specifically mentioning contributions from NeoGenomics, guidelines, and incremental recurrence monitoring coverage. He also inquired about the execution risk associated with the two key payer contracts influencing the 2026 ASP guide of $1,400, asking for quantification of potential ASP impact if contracts are less favorable and the pacing of ASP dynamics throughout the year.

Answer

Susan Bobulsky, Chief Commercial Officer of MRD, Adaptive Biotechnologies, identified EMR integration, particularly Flatiron, and serial testing pull-through as key areas for potential volume upside. She also mentioned optimizing integrated sites and continued focus on blood-based and community testing. Chad Robins, CEO and Co-Founder, Adaptive Biotechnologies, reiterated the five core growth drivers. Kyle Piskel, CFO, Adaptive Biotechnologies, acknowledged some execution risk with the payer contracts but expressed confidence in achieving long-term rates, noting that ASP dynamics would likely be more weighted to the second half of the year. Chad Robins added that multiple levers provide confidence in the ASP guide.

Sebastian Sandler, on behalf of JPMorgan Chase & Co., asked about the impact of the recent NCCN guideline update on multiple myeloma ordering patterns and how unique patient IDs translate to future MRD testing. He also inquired about the MRD Pharma backlog conversion to revenue and any changes in pharma customer behavior.

Answer

CCO Susan Bobulsky stated the NCCN update is a supportive tailwind, reinforcing their message in the community, but it's too early to attribute specific volume increases to it. CFO Kyle Piskel noted the pharma backlog conversion profile is largely unchanged. CEO Chad Robins added that global regulatory support for MRD as an endpoint (ODAC, CHMP) is growing, making them bullish on the pharma opportunity with minimal impact from other macro factors.

Sebastian Sandler, on behalf of Rachel Vatnsdal from JPMorgan Chase & Co., questioned if the strong sequential increase in clonoSEQ volume is a sustainable run-rate and asked if community setting growth is from new or existing accounts.

Answer

Executive Susan Bobulsky expressed confidence in continued sequential growth for the year but remained prudent about the exact magnitude each quarter due to new initiatives launching in the second half. She confirmed that growth in the community setting was driven by both acquiring new accounts and achieving deeper penetration within existing ones.

Sebastian Sandler, on for Casey Woodring of JPMorgan Chase & Co., asked about ICON's role in licensing deals between large pharma and Chinese biotechs, and what percentage of ICON's revenue comes from China.

Answer

CEO Steve Cutler stated that revenue from China is approximately 3%. He explained that while Chinese biotechs use local CROs for domestic trials, they rely on global organizations like ICON for international trials aimed at US and European registration. He views this as a 'medium to longer-term fuel' for the business as Chinese innovation grows.