Open the filing on EDGARStarling Oncology Reports Third Quarter 2026 Financial Results and Updates Full-Year 2026 Guidance
CERRITOS, Calif., November 5, 2026 -- Starling Oncology, Inc. (NASDAQ: STLN) (“STLN” or the “Company”), one of the largest value-based community oncology groups in the United States, today reported financial results for its quarter ended September 30, 2026 and updated it's full-year 2026 guidance.
Recent Operational Highlights
- Specialty Pharmacy Revenue was $109 million, up 44 percent year over year, and gross margin was 24 percent. Continued increase in the capture rate of fills written by Starling physicians was the primary contributor to year-over-year revenue growth in the specialty pharmacy.
- Capitated revenue grew 40 percent year over year in the third quarter, and our medical loss ratio, or MLR, improved sequentially to 81.0 percent, compared to 85.5 percent in the second quarter and 67.8% in the prior year period.
- Starling Nexus, our proprietary utilization management portal, is now live for our network providers who practice in all markets where we have delegated capitation arrangements and is the interface through which prior authorizations are submitted for UM review.
Third Quarter 2026 Financial Highlights
All comparisons are to the quarter ended September 30, 2025 unless otherwise noted
- Consolidated revenue of $169.8 million increased 24.3% from $136.6 million
- Gross profit of $30.7 million, increased 62.1%
- Net loss of $15.7 million compared to net loss of $16.5 million
- Basic and diluted (loss) earnings per share of $(0.13) compared to $(0.14)
- Adjusted EBITDA* of positive $3.4 million compared to $(3.5) million
- Cash and cash equivalents of $36.9 million as of September 30, 2026
*Adjusted EBITDA is a non-GAAP measure and the reconciliation is included in the Financial Information; Non-GAAP Financial Measures section below.
Management Commentary
Daniel Virnich, CEO of Starling, commented, "The third quarter of 2026 was another strong quarter for our company, with revenue up 24% year over year and Adjusted EBITDA of $3.4 million, our second consecutive quarter of positive Adjusted EBITDA and above our third quarter outlook of $0.50 million to $1.5 million. Our capitated business continues to deliver growth, with capitated revenue up 40% and MLR performing at expectations. Our Specialty pharmacy business grew 44% year over year, with strong gross margins of 24% for this segment. Starling Nexus, our proprietary provider-focused portal, is now live and available to our network clinicians to support care coordination and evidence-based care on our delegated capitation model. Based on our performance year to date, we are affirming our full-year 2026 guidance, and we believe we are well positioned for continued growth into 2027."
Fourth Quarter of 2026 Outlook
For the fourth quarter of 2026, we anticipate Adjusted EBITDA** of $3 million to $5 million, as the Company onboards and ramps our Florida delegated lives.
Updated Outlook for Fiscal Year 2026
| 2026 Guidance - Previous | 2026 Guidance - Updated |
|---|
| Revenue | $650 to $670 million | $650 to $660 million |
| Gross Profit | $105 to $110 million | $107 to $110 million |
| Adjusted EBITDA** | $2 to $7 million | $4 to $6 million |
| Free Cash Flow** | $5 to $15 million | $5 to $10 million |
** The Company uses Adjusted EBITDA, Medical Loss Ratio (MLR), and Free Cash flow, each a non-GAAP measure, as an additional tool to assess its operational and financial performance. See "Financial Information: Non-GAAP Financial Measures" below. STLN is not reasonably able to provide a quantitative reconciliation for forward-looking information of Adjusted EBITDA, MLR and Free Cash flow the most directly comparable GAAP financial measures, without unreasonable efforts due to uncertainties regarding capitated lives, direct costs, taxes, capital expenditures, share-based compensation, change in fair value of liabilities, unrealized (gains) losses on investments, consulting and legal fees, transaction costs and other non-cash items. The variability of these items could have an unpredictable, and potentially significant, impact on STLN’s future GAAP financial results.
The Company expects approximately $110 million in capitated revenue in 2026. The Company also anticipates that Medical Loss Ratio, discussed under “Financial Information; Non-GAAP Financial Measures” below, will be in the range of 85% to 90% in 2027 with the onboarding of new lives.
The outlook information provided in this earnings release does not take into account the impact of any unanticipated developments in the business or changes in the operating or economic environment, nor does it take into account the impact of STLN's acquisitions, dispositions or financings. STLN's outlook assumes a largely stable global market, which would likely be negatively impacted if recent tariff rate increases and exchange rate changes persist and adversely affect world trade. The outlook information included in this press release represents management's current estimates as of the date of this release. Actual results may differ materially depending on a number of factors. Investors are urged to read the Forward-Looking Statements included in this release. Management does not assume any obligation to update these estimates other than as required by applicable law.
Webcast and Conference Call
STLN will host a conference call on Thursday, November 5, 2026 at 5:00 p.m. (Eastern Time) to discuss third quarter results and management’s outlook for future financial and operational performance.
The conference call can be accessed live over the phone by dialing 1-800-347-6865, or for international callers, 1-203-518-9757. The conference ID for the live call is STARLING. A replay will be available approximately three hours after the call and can be accessed by dialing 1-844-512-2921, or for international callers, 1-412-317-6671. The access ID for the replay is 11162885. The replay will be available until 11:59 p.m. (Eastern Time) on Thursday, November 19, 2026. The live webcast and replay can be accessed at https://viavid.webcasts.com/starthere.jsp?ei=1780401&tp_key=49fb750904
About Starling Oncology, Inc.
Founded in 2007, Starling Oncology, Inc. (NASDAQ: STLN) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. Formerly known as The Oncology Institute, Starling Oncology offers cutting-edge, evidence-based cancer care to a population of approximately 2.2 million patients including clinical trials, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations. With over 400 employed and network clinicians and over 100 clinics and network locations of care across five states and growing, Starling Oncology is coordinating cancer care for the better. For more information visit www.starlingoncology.com. Please follow us on LinkedIn, X (formerly Twitter), or Bluesky.
Forward-Looking Statements
Forward-looking statements notice
This press release includes forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995, Section 27A of the Securities Act of 1933, as amended (the “Securities Act”) and Section 21E of the Securities Exchange Act of 1934, as amended (the “Exchange Act”). All statements other than statements of historical fact are statements that could be deemed forward-looking statements. Forward-looking statements generally may be identified by words such as “preliminary,” “believe,” “may,” “will,” “estimate,” “continue,” “anticipate,” “intend,” “expect,” “should,” “would,” “plan,” “project,” “predict,” “potential,” “guidance,” “approximately,” “seem,” “seek,” “future,” “outlook,” and similar expressions that predict or indicate future events or trends or that are not statements of historical matters. These forward-looking statements include, but are not limited to, statements regarding projections, anticipated financial results, estimates and forecasts of revenue and other financial and performance metrics and projections of market opportunity and expectations. These statements are based on various assumptions and on the current expectations of STLN and are not predictions of actual performance. These forward-looking statements must not be relied on by anyone as a guarantee, an assurance, a prediction or a definitive statement of fact or probability. Actual events and circumstances are difficult or impossible to predict and will differ from assumptions. Many actual events and circumstances are beyond the control of STLN. These forward-looking statements are subject to a number of risks and uncertainties, including the accuracy of the assumptions underlying the 2026 full fiscal year outlook and the Q4 2026 outlook and our longer-term expectations, including for 2027, as discussed herein, the outcome of judicial and administrative proceedings to which STLN may become a party or investigations to which STLN may become or is subject that could interrupt or limit STLN’s operations, result in adverse judgments, settlements or fines and create negative publicity; changes in STLN’s patient or payors' preferences, prospects and the competitive conditions prevailing in the healthcare sector; failure to continue to meet stock exchange listing standards; and those factors discussed in the documents STLN has filed, or will file, with the SEC, including the Item 1A. "Risk Factors" section of STLN's Annual Report on Form 10-K for the year ended December 31, 2025 filed with the SEC on March 12, 2026 and any subsequent filed Quarterly Reports on Form 10-Q or Current Reports on Form 8-K. If these risks materialize or STLN’s assumptions prove incorrect, actual results could differ materially from the results implied by these forward-looking statements. There may be additional risks that STLN currently is evaluating or does not presently know, or that STLN currently believes are immaterial that could also cause actual results to differ from those contained in the forward-looking statements. In addition, forward-looking statements reflect STLN’s plans or forecasts of future events and views as of the date of this press release. STLN anticipates that subsequent events and developments will cause STLN’s assessments to change. STLN does not undertake any obligation to update any of these forward-looking statements other than as required by applicable law. These forward-looking statements speak only as of the date of this press release and are subject to a number of important factors that could cause actual results to differ materially from those in the forward-looking statements and readers are cautioned to not place undue reliance on these forward looking statements.
Financial Information; Non-GAAP Financial Measures
STLN uses certain financial information and data, such as Adjusted EBITDA, Medical Loss Ratio (MLR), and Free Cash Flow, that have not been prepared in accordance with United States generally accepted accounting principles (“GAAP”) when reporting and discussing its financial results. STLN’s non-GAAP financial measures may not be comparable to similarly titled non-GAAP financial measures used by other companies. The presentation of non-GAAP financial measures is not intended to be considered in isolation or as a substitute for, or superior to, financial measures determined in accordance with GAAP. Because of the limitations of non-GAAP financial measures, you should consider the non-GAAP financial measures presented in this press release in conjunction with STLN’s financial statements and the related notes thereto.
Medical Loss Ratio (MLR): STLN defines MLR as our total direct costs related to capitated contracts divided by the total capitated revenue.
STLN believes that the use of Medical Loss Ratio (MLR) provides management with an additional tool to assess our operational efficiency and commitment to value, to plan and forecast future periods, and to understand the factors and trends in our premium spending. The MLR is utilized by peers across the health industry, and we believe it is helpful to investors in measuring our financial performance and comparing our performance to other health providers. The principal limitation of MLR is that its calculation relies on definitions and allocations that require management's judgment and may not capture all nuances of our administrative efficiency or investment in long-term infrastructure. Direct Costs for capitation include clinical payroll, IV drug costs, network medical expense, and medical supplies.
Free Cash Flow: STLN defines Free Cash Flow as net cash flow provided by (used in) operations plus cash paid for interest, less capital expenditures. STLN believes that the use of Free Cash Flow provides management with an additional tool to assess the Company's financial performance, evaluate its ability to generate cash from operations, and plan for future investments and obligations. Free Cash Flow is useful in understanding the cash available for strategic initiatives. We believe that Free Cash Flow is helpful to investors in measuring our financial performance and comparing our performance to our peers. Free Cash Flow has important limitations as an analytical tool, and should not be considered in isolation, or as a substitute for analysis of our results as reported under GAAP.
Adjusted EBITDA: STLN defines Adjusted EBITDA as net (loss) income plus depreciation, amortization, interest, taxes, non-cash add-backs comprised of one-time write-offs and non-cash rent expense, share-based compensation, goodwill impairment charges, change in fair value of liabilities, unrealized gains or losses on investments and other adjustments to add-back the following: consulting and legal fees related to acquisitions, loss on debt extinguishment, post-combination compensation expense, one-time consulting and legal fees related to certain advisory projects, software implementations and debt or equity financings, severance expense and temporary labor and recruiting charges to build out our corporate infrastructure.
STLN believes that the use of Adjusted EBITDA provides management with an additional tool to assess our operations and results of our performance, to plan and forecast future periods, and factors and trends. We believe that Adjusted EBITDA is helpful to investors in measuring our financial performance and comparing our performance to our peers. Adjusted EBITDA has important limitations as an analytical tool, and should not be considered in isolation, or as a substitute for analysis of our results as reported under GAAP.
A reconciliation of total direct costs and revenue related to capitated contracts to MLR, net cash flow provided by (used in) operations to Free Cash Flow, and net loss to Adjusted EBITDA, the most comparable GAAP metrics, is set forth below:
| Three Months Ended Sept 30, | Change |
|---|
| Medical Loss Ratio (MLR) |
| (dollars in thousands) | 2026 | 2025 | $ | % |
| Direct costs - patient services | $56,239 | $54,572 | $1,667 | 3.1% |
| Direct costs - fee-for-service | (32,988) | (40,615) | 7,627 | (18.8)% |
| Direct costs - capitated | 23,251 | 13,957 | 9,294 | 66.6% |
| Patient services revenue | 60,013 | 60,195 | (182) | (0.3)% |
| Fee-for-service revenue | (31,299) | (39,621) | 8,322 | (21.0)% |
| Capitated revenue | 28,714 | 20,574 | 8,140 | 39.6% |
| Medical loss ratio related to capitated contracts | 81.0% | 67.8% | | 13.2% |
| Nine Months Ended Sept 30, | Change |
|---|
| Free Cash Flow Reconciliation |
| (dollars in thousands) | 2026 | 2025 | $ | % |
| Net cash and cash equivalents provided by (used in) operating activities | $19,867 | $(27,820) | $47,687 | 171.4% |
| Cash paid for interest | 3,568 | 3,036 | 532 | 17.5% |
| Purchases of property and equipment | (3,212) | (2,140) | (1,072) | 50.1% |
| Free Cash Flow | $20,223 | $(26,924) | $47,147 | 175.1% |
| Three Months Ended September 30, | Change | Nine Months Ended September 30, | Change |
|---|
| Adjusted EBITDA Reconciliation |
| (dollars in thousands) | 2026 | 2025 | $ | % | 2026 | 2025 | $ | % |
| Net loss | $(15,748) | $(16,504) | $756 | 4.6% | $(28,029) | $(53,098) | $25,069 | 47.2% |
| Depreciation and amortization | 1,522 | 1,723 | (201) | (11.7)% | $4,976 | $5,312 | (336) | (6.3)% |
| Interest expense, net | 1,815 | 1,920 | (105) | (5.5)% | $5,608 | $9,360 | (3,752) | (40.1)% |
| Income tax and other taxes | 53 | (10) | 63 | (630.0)% | $182 | $(24) | 206 | (858.3)% |
| Non-cash addbacks | 169 | 164 | 5 | 3.0% | $(115) | $2,223 | (2,338) | (105.2)% |
| Share-based compensation | 1,348 | 1,024 | 324 | 31.6% | $4,104 | $3,234 | 870 | 26.9% |
| Changes in fair value of liabilities | 13 | 6,127 | (6,114) | (99.8)% | (1,914) | 13,519 | (15,433) | (114.2)% |
| Unrealized loss on investments | - | - | - | - % | - | 6 | (6) | (100.0)% |
| Loss on debt extinguishment | 11,561 | - | 11,561 | 100.0% | 11,561 | - | 11,561 | 100.0% |
| Post-combination compensation expense | - | 13 | (13) | (100.0)% | - | 39 | (39) | (100.0)% |
| Consulting fees | (637) | 782 | (1,419) | (181.5)% | 1,450 | 1,621 | (171) | (10.5)% |
| Infrastructure and workforce costs | 3,298 | 1,302 | 1,996 | 153.3% | 3,362 | 5,252 | (1,890) | (36.0)% |
| Transaction costs | - | - | - | - % | - | 1 | (1) | (100.0)% |
| Adjusted EBITDA | $3,394 | $(3,459) | $6,853 | 198.1% | $1,185 | $(12,555) | $13,739 | 109.4% |
| Three Months Ended September 30, |
|---|
| Key Business Metrics |
| (dollars in thousands) | 2026 | 2025 |
| Affiliated and Network Clinics | 322 | 80 |
| Markets | 17 | 22 |
| Lives under value-based contracts (millions) | 2.2 | 1.9 |
Number of clinics operated under the STLN PCs, whereby we receive a percentage of revenue under our management services agreements, or MSAs, and are consolidated. Additionally, includes independent oncology practices to which we provide limited management services and have network provider agreements, but do not bear the operating costs.
Consolidated Balance Sheets (Unaudited)
(in thousands except share data)
| September 30, 2026 | December 31, 2025 |
|---|
| Assets | | |
| Current assets: | | |
| Cash and cash equivalents | $36,895 | $33,565 |
| Accounts receivable, net | 60,677 | 58,998 |
| Other receivables | 126 | 322 |
| Inventories | 36,631 | 16,875 |
| Prepaid expenses and other current assets | 3,361 | 2,987 |
| Total current assets | 137,690 | 112,747 |
| Property and equipment, net | 10,594 | 10,684 |
| Operating right of use assets | 21,975 | 22,374 |
| Intangible assets, net | 8,869 | 11,015 |
| Goodwill | 7,230 | 7,230 |
| Other assets | 1,415 | 606 |
| Total assets | $187,773 | $164,656 |
| Liabilities and stockholders’ deficit | | |
| Current liabilities: | | |
| Accounts payable | $82,094 | $43,167 |
| Current portion of operating lease liabilities | 7,268 | 7,156 |
| Accrued expenses and other current liabilities | 29,338 | 20,639 |
| Asset-based revolving credit facility | 5,000 | - |
| Total current liabilities | 123,700 | 70,962 |
| Operating lease liabilities | 17,942 | 19,131 |
| Warrant and conversion option derivative liabilities | 10,941 | 12,855 |
| Long-term debt, net of unamortized debt issuance costs | 72,520 | 77,400 |
| Other non-current liabilities | 25 | 28 |
| Total liabilities | 225,128 | 180,376 |
| Stockholders’ deficit: | | |
| Common Stock, 0.0001 par value, authorized 500,000,000 shares; 103,724,798 and 101,991,024 shares issued and outstanding at September 30, 2026 and 100,596,918 shares issued and 98,863,144 shares outstanding at December 31, 2025 | 10 | 10 |
| Series A Convertible Preferred Stock, 0.0001 par value, authorized 10,000,000 shares; 193,507 shares issued and outstanding at September 30, 2026 and 193,507 shares issued and outstanding at December 31, 2025 | - | - |
| Additional paid-in capital | 263,102 | 256,708 |
| Treasury Stock at cost, 1,733,774 shares at September 30, 2026 and December 31, 2025 | (1,019) | (1,019) |
| Accumulated deficit | (299,448) | (271,419) |
| Total stockholders’ deficit | (37,355) | (15,720) |
| Total liabilities and stockholders’ deficit | $187,773 | $164,656 |
Consolidated Statements of Operations (Unaudited)
(in thousands except share data)
| Three Months Ended September 30, | Nine Months Ended September 30, |
|---|
| 2026 | 2025 | 2026 | 2025 |
|---|
| Revenue | | | | |
| Patient services | $60,013 | $60,195 | $177,927 | $169,154 |
| Specialty Pharmacy | 109,304 | 75,895 | 295,453 | 187,761 |
| Clinical trials & other | 450 | 474 | 5,110 | 3,857 |
| Total operating revenue | 169,767 | 136,564 | 478,490 | 360,772 |
| Operating expenses | | | | |
| Direct costs - patient services | 56,239 | 54,572 | 166,393 | 152,802 |
| Direct costs - specialty pharmacy | 82,858 | 63,072 | 230,947 | 154,021 |
| Direct costs - clinical trials & other | - | - | - | 279 |
| Selling, general and administrative expense | 32,130 | 25,251 | 90,285 | 77,534 |
| Depreciation and amortization | 1,522 | 1,723 | 4,976 | 5,312 |
| Total operating expenses | 172,749 | 144,618 | 492,601 | 389,948 |
| Loss from operations | (2,982) | (8,054) | (14,111) | (29,176) |
| Other non-operating expense (income) | | | | |
| Interest expense, net | 1,815 | 1,920 | 5,608 | 6,479 |
| Change in fair value of warrant and conversion option derivative liabilities | 13 | 6,127 | (1,914) | 13,519 |
| Loss on debt extinguishment | 11,561 | - | 11,561 | 2,881 |
| Other, net | (623) | 403 | (1,337) | 1,174 |
| Total other non-operating expense (income) | 12,766 | 8,450 | 13,918 | 24,053 |
| Loss before provision for income taxes | (15,748) | (16,504) | (28,029) | (53,229) |
| Income tax benefit | - | - | - | 131 |
| Net loss | $(15,748) | $(16,504) | $(28,029) | $(53,098) |
| Net loss attributable to common stockholders, basic and diluted | $(13,292) | $(13,770) | $(23,603) | $(43,878) |
| Net loss per share attributable to common stockholders: | | | | |
| Basic | $(0.13) | $(0.14) | $(0.23) | $(0.49) |
| Diluted | $(0.13) | $(0.14) | $(0.23) | $(0.49) |
| Weighted-average number of shares outstanding: | | | | |
| Basic | 104,728,390 | 97,474,797 | 103,197,885 | 89,333,733 |
| Diluted | 104,728,390 | 97,474,797 | 103,197,885 | 89,333,733 |
Consolidated Statements of Cash Flows (Unaudited)
(in thousands)
| Nine Months Ended September 30, |
|---|
| 2026 | 2025 |
|---|
| Cash flows from operating activities: | | |
| Net loss | $(28,029) | $(53,098) |
| Adjustments to reconcile net loss to cash and cash equivalents used in operating activities: | | |
| Depreciation and amortization | 4,976 | 5,312 |
| Amortization of debt issuance costs and debt discount | 2,614 | 4,294 |
| Write-off of assets from clinical trials segment | - | 2,398 |
| Share-based compensation | 4,104 | 3,234 |
| Change in fair value of liability classified warrants and conversion option derivative | (1,914) | 13,519 |
| Deferred taxes | - | (32) |
| Loss on debt extinguishment | 11,561 | 2,881 |
| Credit losses | 200 | - |
| Loss on disposal of property and equipment | 147 | - |
| Changes in operating assets and liabilities: | | |
| Accounts receivable | (1,879) | (12,949) |
| Other receivables | 196 | (291) |
| Inventories | (19,756) | (8,843) |
| Prepaid expenses | (374) | 1,803 |
| Other assets | (60) | 3 |
| Accounts payable | 39,252 | 11,929 |
| Change in operating leases | (678) | (274) |
| Accrued expenses and other current liabilities | 9,492 | 2,389 |
| Other non-current liabilities | 15 | (95) |
| Net cash and cash equivalents provided by (used in) operating activities | 19,867 | (27,820) |
| Cash flows from investing activities: | | |
| Purchases of property and equipment | (3,212) | (2,140) |
| Proceeds from asset disposition | - | 126 |
| Net cash and cash equivalents used in investing activities | (3,212) | (2,014) |
| Cash flows from financing activities: | | |
| Proceeds from private placement, net of offering costs | - | 15,359 |
| Proceeds from at-the-market offering, net of offering costs | - | 9,952 |
| Proceeds from employee stock purchase plan | 460 | 151 |
| Advances from asset-based revolving facility | 5,000 | - |
| Proceeds from issuance of long-term debt | 75,000 | - |
| Transactions costs related to issuance of long-term debt | (2,597) | - |
| Transactions costs related to issuance of asset-based revolving facility | (778) | - |
| Payments made for financing of insurance payments | (794) | (691) |
| Payment of deferred consideration liability for acquisition | - | - |
| Principal payments on long-term debt | (85,889) | (20,000) |
| Exit fee and make-whole paid on debt extinguishment | (5,540) | - |
| Principal payments on financing leases | (17) | (28) |
| Common stock issued for warrants exercised | 1,628 | 385 |
| Common stock issued for options exercised | 202 | 2,695 |
| Net cash and cash equivalents provided by (used in) financing activities | (13,325) | 7,823 |
| Net increase (decrease) in cash and cash equivalents | 3,330 | (22,011) |
| Cash and cash equivalents at beginning of period | 33,565 | 49,669 |
| Cash and cash equivalents at end of period | $36,895 | $27,658 |
Contacts
Starling Oncology, Inc.
Daniel Virnich, MD danielvirnich@starlingoncology.com
(562) 735-3226 x 81125
ICR Strategic Communications investors@icrinc.com