Can you hear me okay? Perfect. Hi, everyone. Yes, this is Rachel Vatnsdal from the Life Science Tools and Diagnostics team here at JPMorgan. Today, I'm joined by the Guardant Health management team. As a reminder, these are 40-minute sessions. First half, roughly, will be prepared remarks, followed by Q&A. And so with that, I will pass it off to Helmy.
Thank you, Rachel. It's always great to be here. And thank you, everyone, for joining us today. Please note our forward-looking statement. We founded Guardant Health 12 years ago with the bold mission of giving us, our families, friends, and loved ones all more time free from cancer, a disease that we believe could be ultimately conquered using vast amounts of data as our weapon. And in those 12 years, we have delivered on that mission. We have launched tests across the continuum of patient care, with our very first version of Guardant 360 launching into the late-stage cancer market in 2014. In 2021, we launched Guardant Reveal for cancer recurrence and monitoring.
And just a few months ago, on August 1, we were thrilled to launch our first FDA-approved test into the asymptomatic cancer screening market with Shield, unlocking an exciting opportunity to potentially impact millions more individuals across the cancer continuum. As is our practice, I would like to start off with a story illustrating the important impact our tests can have on improving patients' lives. In June of this year, Robert, a 68-year-old father of three, started seeing a primary care physician at the urging of his sister. He had previously never been screened for colon cancer, and his new PCP ordered a Shield test. Unlike traditional screening methods, he was more amenable to it since it was a quick blood test that could be conducted in his primary care provider's office. The result came back positive.
A follow-up colonoscopy soon after revealed adenocarcinoma of the splenic flexure, as well as tubular adenomas. He underwent surgical resection later in the year to remove the stage II cancer that had, thankfully, not spread beyond the walls of his colon. Given how early the cancer was found, the procedure was curative, and no chemotherapy or radiation was needed. Since then, Robert has reported feeling back to himself and grateful that a simple test like Shield was able to help detect his cancer early and get him on a road to recovery quickly.
These stories are the fuel that drive our relentless work. Our achievements across our business have resulted in remarkable growth over the last few years, most notably with very strong 31% year-over-year growth in 2024. Looking back on last year, it was really an outstanding year for Guardant. We delivered many key milestones across our portfolio.
We continued to grow therapy selection and expand its profitability while completing a major upgrade of our flagship Guardant360 test onto our new Smart L iquid Biopsy platform. We grew Reveal volumes and continued generating evidence to support reimbursement. We received FDA approval and Medicare coverage for Shield, our screening blood test for CRC that is now in the early innings of an exciting launch for the field. We believe we are well positioned in each aspect of our business for continued growth in 2025. Now, let's take a closer look at each of our business areas, starting with therapy selection, where we are the liquid biopsy leader. This market consists of approximately 700,000 advanced cancer patients in the United States and a total addressable market at scale of approximately $10 billion.
The U.S. market continues to present a very large opportunity for us, and we have made strong and measured progress internationally as well. We saw incredibly strong year-over-year oncology clinical revenue growth of 34%. Oncology testing volumes, ASP improvement, and reimbursement wins continue to be key drivers of this growth. We ended the year especially strong with 24% year-over-year growth in the fourth quarter. This brought total oncology clinical volumes growth to approximately 20% year-over-year in 2024, largely driven by Guardant360, and with the positive traction we're seeing from our launch of Guardant360 LDT on Smart Liquid Biopsy, we expect an acceleration of Guardant360 volume growth in 2025. Throughout 2024, we saw continuing improvements in Guardant360 ASPs. At our investor day in September of 2023, we stated our goal was to reach an ASP of $3,000 for Guardant360 by 2028.
Since that time, we have received an increase to our Guardant 360 LDT Medicare rate from $3,500 to $5,000 and have seen significant improvements in both the amounts we have been paid for our tests and the speed at which we have been paid by commercial payers. As a result, we are very pleased to report that we have achieved our long-term Guardant 360 ASP goal of $3,000 in the second half of 2024, roughly four years ahead of target.
Further tailwinds for us are the recent increase in pricing for our tissue product from $3,100 to $3,500, affecting the beginning of this year, improvements in reimbursement from state biomarker laws, and opportunities to continue to expand commercial coverage. In late July, we transitioned our Guardant 360 LDT onto our Smart Liquid Biopsy platform, representing the most significant upgrade to our flagship precision oncology product.
Guardant360 was already the leading liquid biopsy test for advanced cancer patients with industry-leading performance and turnaround time, and the improved platform positions us for continued robust growth and share gain. The new and upgraded test, now called Guardant360 Liquid, expands the number of genes by nearly tenfold, includes all guideline-recommended genomic markers for solid tumors, and improves the sensitivity for tumor burden detection by a factor of 10. This year, we plan to continually add new applications to the test as we clinically validate additional functionality, and as we test more patients and collect more data, it improves our ability to generate an almost unlimited number of differentiated applications on the platform.
Soon, through these additional apps, Guardant360 Liquid will help identify more patients for existing therapies that are undetectable by current CGP tests, detect harmful adverse effects of chemotherapy, and provide detailed phenotypic information about the tumor, such as histology, subtype, and much, much more. Now, shifting gears a bit, we have also seen excellent uptake of our TissueNext product. And given that success, we are doubling down on our foray into the tissue side of the CGP market with the launch of a new product called Guardant360 Tissue.
With Guardant360 Tissue, we are applying the unique capabilities of our smart platform technology to enable first-of-the-kind clinical features to advance the state-of-the-art in tissue CGP testing. We look forward to providing more updates around this exciting new product later this year. In 2024, we had a very strong year for biopharma, with revenue growing 31% year-over-year.
This growth has been fueled by working with now more than 180 biopharma partners. A major catalyst for this growth is excitement around our Smart Liquid B iopsy platform, with biopharma testing from this new platform now representing over 50% of reported samples and new contracts. This traction with our new technology platform has led to multiple strategic partnerships with top 20 global biopharma companies, which we will be announcing soon.
Looking ahead this year, we are seeing tremendous growth and opportunity for all our products across therapy selection. As a result of the great progress we have made last year, we are more confident than ever that our oncology business will continue to see strong growth over the next few years, driven by our multiple major product upgrades, growing use cases of therapy selection in both early and late-stage settings, as well as international expansion.
Now, let's take a look at our MRD business. The market is comprised of about 18 million early cancer patients and cancer survivors, which represents a $20 billion TAM in the U.S. at scale. Our approach, which is tissue-free, requires only a blood sample. This compares to tumor-informed approaches, where one needs to physically obtain a tissue specimen for the tumor and sequence it to be able to test the patient. The tissue-free approach can certainly be more technologically challenging, but we believe it will ultimately serve the largest portion of the emerging MRD market opportunity. Specifically, of the 18 million total cancer patients in the U.S. that would benefit from MRD testing, more than 12 million patients are more than five years out from surgery, making it much more difficult to obtain a tissue sample for those patients.
Furthermore, more than three million do not have tissue available at all and thus can only be addressed with a tissue-free test. Finally, with less than 3% of total addressable patient population currently receiving MRD testing today, this presents a huge greenfield opportunity ahead of us. In August 2024, data from our COSMOS Colon study looking at stage II and stage III patients was published in the peer-reviewed journal Clinical Cancer Research.
The study demonstrates that the high-performance Guardant Reveal and our Smart Liquid Biopsy platform can achieve in this challenging setting. Reveal demonstrated 81% sensitivity with 99% specificity in the surveillance setting, and the assay itself has an analytical limit of detection down to 0.005%, all without the need for tissue. This data was also submitted last year to MolDX for Medicare reimbursement for the CRC surveillance MRD indication, and review is ongoing.
Beyond CRC surveillance, we have an extensive pipeline of clinical cohorts for establishing validity and utility for Guardant Reveal. Accordingly, we are also excited to report that we have submitted data for publication supporting potential Medicare reimbursement for coverage in breast cancer and therapy monitoring. Looking ahead, we have important ongoing clinical validity studies for additional cancers that we look forward to providing updates on throughout the year.
We are excited by the demand that we are seeing in the tissue-free MRD market, and there are multiple near-term inflection opportunities in 2025. We continue to make good progress towards CRC surveillance reimbursement, which will improve our ASP. We have also made significant progress on COGS reduction initiatives for Reveal. As a reminder, these two milestones will be a significant step towards our long-term goal of achieving greater than 60% gross margins for our MRD business.
Once we have CRC surveillance reimbursement in place, the improvements we have made on a cost per test for Reveal will bring our margins to a place where we will start to push on Reveal and accelerate volumes. We have built an incredible product portfolio over the last decade, spanning the entire continuum of cancer care. As groundbreaking as the individual tests in our portfolio are, what is even more exciting is that all these products are built off of and share the very same Smart Liquid Biopsy platform.
This means that all of our tests, from Shield to Reveal to 360, work together synergistically across the entire spectrum of cancer care. Data collected from one test is seamlessly mergeable with data from another test. It is effortless for oncologists to reflex from Reveal to 360 and back again, creating a truly differentiated platform experience.
Because the technology foundation is shared, the clinical information we can provide also gets richer and richer as physicians use more of our tests for each patient, creating a very sticky user experience. We look forward to sharing more as we continue to populate our testing ecosystem with clinical applications driven not just by single products, but by the entire platform. With that, I'll now turn it over to AmirAli to detail our progress in screening and close out the presentation.
Thanks, Helmy. Turning now to our work in cancer screening, where we are pioneering a new category of screening tests with our blood-based assay. Here, we are addressing a $50 billion opportunity for 120 million average-risk individuals across the United States. From the very beginning, our goal has been to identify and catch many cancer types early when they are most treatable, improving the lives of patients.
With that vision in mind, we develop our Shield assay as a platform capable of multi-cancer detection with its first indication in CRC screening, an indication with established regulatory and reimbursement pathway. In late July, Shield was approved by the FDA as a primary screening option for colorectal cancer for adults ages 45 and older who are at average risk for the disease. It is the first blood test to be approved as a primary screening option for CRC, meaning healthcare providers can offer Shield in a manner similar to all other non-invasive methods recommended in screening guidelines. This approval came on the heels of a robust pivotal study, Eclipse, whose results were published in the New England Journal of Medicine.
Importantly, in real-world clinical use, we continue to see an incredibly strong adherence rate of over 90%, which means over 90% of the patients, in fact, completed the blood draw for Shield test ordered. This industry-leading rate demonstrates how convenience is highly valued in the marketplace. Upon our FDA approval, Shield was covered for all 45 million Medicare beneficiaries at average risk of CRC. We are very pleased that Shield was recognized as an important new class of CRC screening and received a favorable Medicare price of $920. We expect upon securing advanced diagnostic laboratory test or ADLT status designation, the Medicare rate for Shield will be at an even more favorable price of $1,495. We recently received a unique PLA code for Shield test and are expecting to get ADLT status designation later this year.
We've been very excited to see the interest in Shield from stakeholders across our industry and beyond. In 2024, we earned innovation awards from Time Magazine and Popular Science. CMS continued to be progressive and patient-centric and announced they were removing out-of-pocket costs for any diagnostic colonoscopy following a positive Shield test shortly after our launch. The American College of Gastroenterology, or ACG, noted in their recently published patient fact sheet about Shield that this test could be beneficial for patients who may not care to do a stool test or colonoscopy.
Numerous cancer and CRC advocacy groups have published or shared positive sentiments regarding Shield. In particular, they highlight how Shield's blood test modality will help improve access to patients by adding a more pleasant and convenient screening option. To capture this demand, we are ramping our commercial infrastructure.
We have already increased our field force to over 100 reps, with plans to continue expansion throughout the year. We built a national network of more than 40,000 phlebotomists, making it easy for patients to find fast and convenient access to Shield. We are also expanding our EMR integrations, enabling direct ordering in systems that providers already use today. We have already integrated with athenahealth EMR and are expanding to eClinicalWorks and Epic EMR systems in 2025. In early August, just a few days after FDA approval, we are thrilled to launch our Shield IVD assay. Our strategy is to focus on the covered patient population, driving a high mix of covered reimbursable tests, and we are already seeing outstanding reception from physicians and patients.
In Q4, the first full quarter following our commercial launch, we reported approximately 6,400 tests and recognized approximately $4 million of Shield testing revenue, driven by a majority of samples coming from covered Medicare beneficiaries. I'm happy to report that our first full quarter of launch, we achieved gross margin breakeven for Shield, as our COGS were approximately $600, which was in line with the Shield ASP of approximately $600. In fact, with the current rate of improvement, we are expecting Shield to be gross margin positive in its first full year. Reaching gross margin breakeven much sooner than we originally anticipated gives us more opportunity to expand our commercial infrastructure in 2025, while we keep our annual screening cash burn target of $200 million.
Looking further out, we are also making good progress with our automation and workflow improvement and are on track to reach our target COGS of about $200 at scale expected in 2028. As we recently announced, Shield has been selected for the NIH Vanguard Multi-Cancer Detection, or MCD, study through a highly competitive process. NIH's decision to select Shield recognizes Guardant as a leader in the field of MCD.
To qualify for the Vanguard study, the MCD test needed to detect the presence of cancer across a variety of cancer types with good sensitivity and also be able to accurately predict the cancer site of origin. Collaborating on the Vanguard study provides a unique opportunity for Guardant to engage with top leading stakeholders, including both NCI and FDA, on our Shield MCD clinical validation and the development of the follow-up diagnostic pathways for patients post-MCD testing.
This study is mainly funded by NIH, with only minimal R&D investments from Guardant Health. We ended the year strong, with revenue growing 29% in the fourth quarter, bringing our full-year revenue growth to 31% compared to the prior year. We continue to be focused on our cash burn and materially reduce our burn this year. Therapy selection is already free cash flow positive as of 2024. We expect MRD to reach free cash flow breakeven by the end of 2026, and we are committed to approximately $200 million cash burn for screening during our scaling period. We ended 2024 with $944 million cash and expect we will reach cash flow breakeven in 2028, with cumulative free cash outflow of $450-$550 million over the next three years. We have a number of key catalysts across our business coming this year.
Across oncology, we expect clinical volumes to grow more than 20%, supported by volume acceleration across all products. In screening, we look forward to sharing data for multi-cancer and reaching key milestones for Shield CRC in its first full year of commercial launch. With that, I turn it back over to Rachel for Q&A. Thank you.
Thank you for that presentation. Thank you for that. So maybe just first up, wanted to dig into the pre-announcement. You guys announced this morning that you had revenues well above the street. So wanted to kind of dig into some of the trends there. Obviously, you broke out some of the Shield contributions, so we'll go into that in a minute. But I wanted to ask on the core business, what really drove the quarter there, whether that was across different product lines, ASPs versus volumes? How should we think about that?
We'll start, and then Mike, you can fill in the gaps there. We are very pleased with the business across the board. Clinical volumes were very good. We saw really strong traction with Guardant360 LDT on Smart Liquid Biopsy. And that really, I think, drove a lot of the sort of growth in terms of clinical volumes that we saw, at least the majority of it. Saw strong traction for Guardant Reveal, and then biopharma also was very strong. And then, obviously, ASPs continued to come in very nicely.
Perfect.
Yeah, I mean, I would just add our ASP again for Guardant360 in the Q4 was around $3,000. So I think we've got to a consistent level there. We also had in the quarter this usual true-up effect that we saw the upside on Guardant360. That was about $7 million in the quarter. But yeah, I think ASPs have been the success story for us on Guardant360 for the year.
Yeah. Maybe going off of that, so your Guardant360 ASP target came in at around $3,000 this quarter. That's well ahead of your schedule where you were targeting to reach that by 2028. So how much more runway do you really think there is at this point on the Guardant360 ASP line?
Yeah, I think there's still room to grow. Yeah, we got to the $3,000 mark about four years ahead of target. Really, our focus now is on expanding commercial coverage for Guardant360. There are still some gaps from the national payers in what they cover for Guardant360. Some cover the CDx version and not the LDT, and some vice versa, and some of the national payers are only covering certain cancer types, so I think our focus is to just continue to expand that coverage. We think we could probably now take that target in 2028, ASP to something like $3,200, $3,300. We're not going to see the same major step up that we saw in 2024. We won't see that again in 2025, but I think we can have continued increases over the next few years.
Perfect. That's helpful. Then maybe if we look at 2025, you had previously pointed us towards this 20% clinical volume growth in 2024, and you said that you would expect to accelerate that above 20% in 2025 prior to including any of the contributions from Shield. So can you walk us through what gives you confidence in hitting that volume growth again this year? And how should we think about the various contribution from tests like Guardant360, Reveal, TissueNext?
Yeah, I think we have a lot of confidence given the traction we see in the second half of last year around Guardant360 on Smart Liquid Biopsy. So we're off to a really good start in terms of this year. Reveal, as we mentioned, there's a big catalyst for us once we get CRC reimbursement on the surveillance setting. That being said, Reveal was our fastest-growing oncology product, even with us sort of managing volumes last year. So we know there's a lot of demand there. And then we're very excited for this new tissue launch this year, and we think that's going to be an important catalyst as well.
Perfect. Then on Shield, so you pre-announced this morning that you had roughly 6,400 tests of Shield in Q4 with roughly $4 million of revenue there. So can you provide any color for us in terms of how should we think about that volume split? How much of it was self-pay patients versus commercial Medicare? And how should investors really think about that volume trajectory for Shield as we go throughout the first year here?
Yeah, so self-pay part is like not really material. So everything is through regular clinical testing and going after the insurance and the payers. Vast, vast majority of the samples were coming from Medicare beneficiary, and that was intended and actually our plan to really go from Medicare being a minority of our sample mix to becoming a majority of sample mix so we can have better unit economics and have better kind of profitability and scalability.
Perfect. And sticking on the topic of Shield, just regarding the V2 data, can you walk us through how much of an improvement should we really expect relative to V1, particularly on the advanced adenoma side? And then can you elaborate on any of the differences in terms of the process of bringing that V2 version to market and kind of the timeline that we should expect there?
Yeah, just as a reminder, maybe for some new investors, so we got FDA approval for Shield. We called it Shield V1 with the performance that we are very excited about and the doctors are very excited about. But that's not the last version of Shield and Guardant. We have the track record of continuous improvement and innovation to make our products even better. So Shield V2, I'm actually excited with where we are. We mentioned in the slides that we are expecting that data and approval and launch sometime in 2025. And literally, it's almost just one year after getting the V1 to the finish line, potentially having this V2 in the market as an upgraded version.
What we know is we know analytically Shield V2 is a more sensitive test. It's just an optimized algorithm. The assay is exactly the same. But clinically, we don't know if that translates into better performance. What we expect if clinical performance gets better is just on the CRC side, just stage one CRC as stage two and above. We had 100% sensitivity, so it's hard to increase that. But AA, we don't expect the Shield V2 to change AA performance.
Perfect. Then maybe just moving over to multi-cancer, you've talked about the opportunity there and really taking more of a platform approach, just given what you've done in Shield so far. So can you talk to us more about that approach and what should we expect in the future in terms of expanding indications and that multi-cancer testing opportunity? So we had this vision of a blood test for multi-cancer detection from the beginning.
It's even why we named this company Guardant Health. Annual Checkup with a simple blood test to detect multiple cancers all at the same time. But our strategy has been different than some other players in the marketplace. We wanted to make sure at the end patient gets access to this test, which means we need to at the end convince payers and regulators to get behind this test. And CRC was our lead indication to really get to that point. CRC was the first indication that had FDA approval pathway, CMS pathway, and we are very pleased to get to that point. And now additional indication can just get added to the same test because the assay and data is the same thing.
It's just a different algorithm that can look at multi-cancer signatures within the same panel of epigenomic and genomic content that we are looking at.
Perfect. One more question on Shield, but more just on the competitive front. Obviously, we've had a few readouts from blood-based colorectal cancer screening tests recently. So how are you thinking about Shield's first mover advantage and how does that kind of build your competitive moat going forward?
So getting to the point of the performance we saw with Shield V1 was not easy to achieve. We are looking at 3,000 biomarkers with NGS, with a highly innovative assay and bioinformatics pipeline. So we are monitoring the field to see what other competitive readout is going to show. But one thing that for sure it's not going to change is probably at least we are going to have two and a half years time advantage relative to any other competing assay to get FDA approval and commercialize such test as an FDA-approved test. And that's such a long lead time would give us a lot of opportunity to build this business and brand as we monitor other competitive readouts.
Perfect. Then just shifting over to MRD, you guys have all mentioned that 2025 really poses an inflection opportunity for Reveal. So can you walk us through some of your excitement regarding MRD in 2025?
Yeah, right now we really just have one indication right now in the adjuvant setting for colorectal cancer. Really, I think the exciting opportunity, especially for a tissue-free approach, is really in the surveillance setting where patients are years out or they don't have tissue. That's really what we're sort of in the we think late-stage innings in terms of our reimbursement review. Hopefully we'll get that in the next few months. Once we're there, I think that's really where we can sort of see positive gross margins in our business in terms of where ASPs will be, and we can really sort of push those volumes out.
I think we mentioned in the prepared remarks that we submitted data for publication for breast and for therapy monitoring as well. We're really seeing the gears turning in terms of the clinical data, and we're hopeful that there'll be a very quick series of submissions to MolDX and Medicare expansion.
Yeah, maybe digging into that a little bit further, just regarding that Medicare reimbursement for surveillance and CRC. Can you walk us through the latest timeline expectation for that, and how are you thinking about the opportunity from the reimbursement piece?
Yeah, as we mentioned last year, we think it'll be in the early part of this year, so we're hopefully just a couple of months away in terms of getting that through the finish line. We've been very pleased with the process so far. And like I said, I think breast and other indications won't be that far behind.
Great. And then on the gross margin line for Reveal, you talked about the possibility of gross margins flipping positive for Reveal in 2025. So how should we think about the trajectory of that and kind of the exit rate as we head into next year for Reveal gross margins?
I'll talk maybe more about the sort of longer-term projections. We think in 2028, we can certainly get to ASPs of about $1,000, and we're very confident we can achieve over 60% gross margins there. I think we'll make a big part of that sort of progress this year, but obviously it'll take some time to sort of grow into the ASP in terms of not only getting surveillance reimbursement, but getting ADLT status and then seeing where we sort of get to with some of the private payers. We think the state biomarker laws will be helpful in terms of getting some coverage there.
Great. Maybe shifting over to biopharma. That's a business that's performed extremely well throughout the year. You've lifted guidance on that as well. So what was really driving the strength in the biopharma segment, and at what point do we expect to see this momentum really carry over to the clinical side as well?
Yeah, no, it's been a really stellar year for us in 2024 in terms of biopharma growth. That's sort of an area that has been sort of a kind of tough area for some of the tools companies. And so it's exciting to see us kind of do really well there. And I think a large part of that has been sort of the reordering and restructuring of some of the big programs and large biopharma because of IRA and the fact that some of these biopharma companies are going after larger indications first. And so when they do that, they need to ensure a higher probability of technical success.
They do and do a lot more testing to really make sure they're going after the right targets. So we've been a beneficiary of that. We've seen really volume increases. Our Smart Liquid Biopsy program with our platform, with its sort of epigenetic component, has been very useful, especially in areas outside of traditional targeted therapy or sort of genomic-driven medicines, areas like ADCs and so on. So we've just seen a lot of traction, a lot of uptake, both in retrospective samples, prospective samples. I think we signed a record number of CDx deals as well. So it bodes really well for where we're going in 2025.
Perfect. Maybe sticking on that Smart Liquid Biopsy opportunity, can you spend a few minutes just walking us through that? And also, how should we think about that impact in the profitability standpoint for Guardant as well?
I think right now, we sort of think of these technology upgrades, especially these major ones, as sort of sawtooth functions where you see an increase in COGS like initially when we roll those out. But as we get volumes in place, automation and so on, and get scale, then we sort of continue the trajectory downwards in terms of expanding margins.
So I think we're through the worst of it, so to speak. Now we're in a really good spot in terms of where the margins are. But we're very excited. We've sort of put the pieces in place last year. And the pieces themselves, we couldn't be more thrilled with them in terms of where 360 is, where the Reveal is, where Shield is, and so on. And now all of these really, and as I said, share this sort of unified platform.
Now it's about how these pieces come together. When we think about 360 and what we'll be able to do, there's just so much that's clinically actionable that we're finding with this platform. Things like seeing essentially patients right now that are being missed for immunotherapies, that are being missed for PARP inhibitors, patients that are being missed in terms of their actual tumor subtype changing, and they're being directed to the wrong therapies. We're able to see all of this with this epigenetic lens now, which is very exciting. Even more exciting is how these tests can work together. The data stream that comes from Reveal is the same data stream that comes from 360. We can see a sort of continued progression of the underlying data that's there.
And so we'll be able to create applications that essentially merge these tests together and make each successive test stronger and more clinically valuable.
Perfect. And then you highlighted EMR integration during the presentation. So can you walk us through just how much left is there really to unlock in terms of the opportunity on EMR integration driving the portfolio?
Still a lot. I think we're now approaching maybe 50% of the oncology tests either being ordered through our digital portal or through an EMR integration. But there's still a lot of work to do, not just with Epic, but some of the other providers that are out there. And it's an area that we're investing heavily in.
Perfect. Another highlight of this year was just the improved visibility that you guys had on the OpEx line and also on cash burn and you reduced both of those data points throughout the year from Guardant's perspective as well. So how should we think about that momentum continuing into 2025 and beyond, especially on the visibility on the OpEx side, given the areas that you're investing in the portfolio?
Yeah, on the OpEx side, I think we're at a point now, particularly with therapy selection and MRD, where we can really get a lot of operating leverage out of the infrastructure that we've built. So when we look at those two businesses, really, we see the OpEx in 2025 being relatively flat. We've got a good, healthy R&D line. We don't need to increase that. We've built out the commercial infrastructure.
There's not a lot that we need to expand there. And on the G&A side, again, that's well built out now to support a business of the size that Guardant is. I think the one area of investment that we'll see in 2025 is really going to be focused on the sales and marketing line for screening. And we ended the year with 100 people in the field. And obviously, we're going to expand that over the next 12 months. So I think when we come to give our guidance, I'm sure we'll provide guidance on cash burn. We expect that to, again, have a reduction in 2025. And again, I think on the OPEX lines, really, you'll see the investment just being there in screening to drive the top line as fast as we can.
Perfect. Then, maybe in the final minute or two as we wrap up, Helmy and Amir Ali, I was wondering if you could both share. What do you think is the most underappreciated aspect of the Guardant story?
I think it's hard to just name one. So, I think when we look at 2025, it's going to be a very interesting year for us when Reveal is coming to the inflection point, positive gross margin, we uncapped the growth. On the Shield side, I think we are going to show how big of an opportunity and how game changer this underappreciated brand could be. And we are not just going to stay at CRC, as we talked about. This test is going to get into other cancer types in the near future, and we are excited to see those days.
Yeah, no, I agree with that. I think what I alluded to is the fact that not only do we have these tests there, but I think people are going to be really surprised how sort of synergistic these tests are, how much data we can unlock, and frankly, the explosion of applications we'll be able to provide over the coming year is not just multi-cancer, but applications around Reveal and therapy selection and so on.
Perfect, and with that, we are out of time, so thank you, everyone, for joining us. Guardant team, thank you for joining us as well.
Thank you.