STOCK TITAN

Starling Oncology (STLN) lifts 2026 revenue and EBITDA guidance

(High)
(Neutral)
Form Type
8-K

Rhea-AI Filing Summary

Starling Oncology, Inc. reported strong Q2 2026 results, with total operating revenue of $161,282 thousand, up from $119,802 thousand a year earlier, and CEO commentary noting revenue grew 35% year over year. Net loss narrowed to $(9,789) thousand and Adjusted EBITDA turned positive at $229 thousand.

For the first six months of 2026, cash provided by operating activities improved to $9,725 thousand from $(15,190) thousand, supporting cash and cash equivalents of $41,094 thousand at June 30, 2026. Management highlighted growth in capitated revenue, which reached $27,974 thousand in Q2, and lives under value-based contracts of 2.1 million.

Reflecting this momentum, the company raised full‑year 2026 guidance, now expecting revenue of $650 to $670 million, gross profit of $105 to $110 million, and Adjusted EBITDA of $2 to $7 million, while reiterating projected Free Cash Flow of $5 to $15 million.

Positive

  • Raised 2026 guidance to $650–$670 million revenue, $105–$110 million gross profit, and $2–$7 million Adjusted EBITDA, reflecting higher expected scale and improved profitability versus prior guidance.
  • First-half 2026 cash from operating activities reached $9,725 thousand and Free Cash Flow was $9,531 thousand, a substantial improvement from negative levels in 2025.

Negative

  • The company remains unprofitable, with Q2 2026 net loss of $9,789 thousand, an accumulated deficit of $283,700 thousand, and a total stockholders’ deficit of $(24,914) thousand.

Filing Explained

The August 6 8-K reports 102,202,753 common shares outstanding and a $24,914 thousand stockholders’ deficit at June 30.

As a Form 8-K, this filing reports a specified material event; here, Item 2.02 furnishes Starling Oncology’s second-quarter results and updated 2026 guidance. The guidance is management’s estimate as of August 6, 2026, not a completed financial result; the release says actual results may differ materially and that the outlook excludes the impact of acquisitions, dispositions, or financings.

At June 30, 2026, the company reported 102,202,753 common shares issued and outstanding, compared with 100,596,918 issued and 98,863,144 outstanding at December 31, 2025. It also reported a stockholders’ deficit of $24,914 thousand, compared with $15,720 thousand at year-end.

The same June 30 balance sheet reported $41,094 thousand of cash and cash equivalents, $79,867 thousand of long-term debt, and $203,147 thousand of total liabilities against $178,233 thousand of total assets.

Item 2.02 Results of Operations and Financial Condition Financial
Disclosure of earnings results, typically an earnings press release or preliminary financials.
Item 9.01 Financial Statements and Exhibits Exhibits
Financial statements, pro forma financial information, and exhibit attachments filed with this report.
Total operating revenue Q2 2026 $161,282 (thousands) Three months ended June 30, 2026 total operating revenue
Net loss Q2 2026 $(9,789) (thousands) Three months ended June 30, 2026 net loss
Adjusted EBITDA Q2 2026 $229 (thousands) Three months ended June 30, 2026 Adjusted EBITDA
Cash from operating activities H1 2026 $9,725 (thousands) Six months ended June 30, 2026 net cash provided by operating activities
Free Cash Flow H1 2026 $9,531 (thousands) Six months ended June 30, 2026 Free Cash Flow reconciliation
2026 revenue guidance (updated) $650 to $670 million Updated full‑year 2026 revenue outlook
Cash and cash equivalents $41,094 (thousands) Cash and cash equivalents at June 30, 2026
Lives under value-based contracts 2.1 million Key business metric as of Q2 2026
Adjusted EBITDA financial
"STLN defines Adjusted EBITDA as net (loss) income plus depreciation..."
Adjusted EBITDA is a way companies measure how much money they make from their core operations, like running a business, by removing certain costs or income that aren’t part of regular business activities. It helps investors see how well a company is doing without distractions from unusual expenses or gains, making it easier to compare companies or track performance over time.
Medical Loss Ratio (MLR) financial
"Medical Loss Ratio (MLR): STLN defines MLR as our total direct costs..."
Free Cash Flow financial
"Free Cash Flow: STLN defines Free Cash Flow as net cash flow provided..."
Free cash flow is the amount of money a company has left over after paying all its expenses and investing in its business, like buying equipment or updating facilities. It shows how much cash is available to reward shareholders, pay down debt, or save for future growth. This helps investors understand if a company is financially healthy and able to grow.
capitated revenue financial
"The Company expects approximately $150 million in capitated revenue in 2026."
Capitated revenue is the fixed amount a healthcare provider or insurer receives for each enrolled patient over a set period, like a monthly subscription fee paid regardless of how much care the patient uses. It matters to investors because it creates predictable cash flow and rewards efficient care, but also transfers financial risk to the provider if patient costs exceed the fixed payments, affecting profitability and future valuation.
value-based contracts financial
"Lives under value-based contracts (millions)"
Total operating revenue $161,282 (thousands) Up from $119,802 (thousands) in Q2 2025
Net loss $(9,789) (thousands) Improved from $(17,009) (thousands) in Q2 2025
Adjusted EBITDA $229 (thousands) Increased from $(4,090) (thousands) in Q2 2025
Cash from operating activities (six months) $9,725 (thousands) Improved from $(15,190) (thousands) for the six months ended June 30, 2025
2026 revenue guidance $650 to $670 million Raised from prior guidance of $630 to $650 million
Guidance

Updated 2026 outlook calls for revenue of $650 to $670 million, gross profit of $105 to $110 million, Adjusted EBITDA of $2 to $7 million, and Free Cash Flow of $5 to $15 million.

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FAQ

How did Starling Oncology (TOI) perform financially in Q2 2026?

Starling Oncology reported Q2 2026 operating revenue of $161,282 thousand, up from $119,802 thousand a year earlier. Net loss narrowed to $(9,789) thousand, and Adjusted EBITDA turned positive at $229 thousand, compared with $(4,090) thousand in Q2 2025.

What updated 2026 guidance did Starling Oncology (TOI) provide?

The company now expects 2026 revenue of $650 to $670 million, gross profit of $105 to $110 million, and Adjusted EBITDA of $2 to $7 million. It maintained projected Free Cash Flow of $5 to $15 million for the year.

How did Starling Oncology (TOI) cash flow change in the first half of 2026?

Net cash from operating activities improved to $9,725 thousand for the first six months of 2026, from $(15,190) thousand in 2025. Free Cash Flow similarly improved to $9,531 thousand, compared with $(14,568) thousand in the prior-year period.

What is Starling Oncology (TOI)’s outlook for Q3 2026 Adjusted EBITDA?

For Q3 2026, management anticipates Adjusted EBITDA of $500 thousand to $1.5 million. This outlook reflects the onboarding and ramp of Florida delegated lives and assumes a largely stable global market environment, excluding unforeseen business or macroeconomic developments.

How many patients are under Starling Oncology (TOI) value-based contracts?

Lives under value-based contracts totaled 2.1 million as of Q2 2026, up from 1.9 million a year earlier. This reflects the company’s expansion in value-based oncology arrangements across its markets and supports growing capitated revenue.

What does Starling Oncology (TOI)’s balance sheet look like at June 30, 2026?

Total assets were $178,233 thousand and total liabilities were $203,147 thousand at June 30, 2026. Long‑term debt (net) stood at $79,867 thousand, and total stockholders’ deficit was $(24,914) thousand, indicating liabilities exceeded equity.
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UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

___________________________________

Form 8-K

__________________________________________________________

 

CURRENT REPORT

Pursuant to Section 13 or 15(d)

of the Securities Exchange Act of 1934

 

Date of Report (Date of earliest event reported)  August 6, 2026

___________________________________

 

STARLING ONCOLOGY, INC.

(Exact name of registrant as specified in its charter)

___________________________________

 

Delaware   001-39248   84-3562323
(State or other jurisdiction
of incorporation)
  (Commission File Number)   (I.R.S. Employer
Identification No.)

 

18000 Studebaker Road, Suite 800, Cerritos, CA   90703
(Address of principal executive offices)   (Zip Code)

 

Registrant’s telephone number, including area code:  (562) 735-3226

 

THE ONCOLOGY INSTITUTE, INC.

(Former name or former address, if changed since last report)

 

Check the appropriate box below if the Form 8-K filing is intended to simultaneously satisfy the filing obligation of the registrant under any of the following provisions:

 

Written communication pursuant to Rule 425 under the Securities Act (17 CFR 230.425)

Soliciting material pursuant to Rule 14a-12 under the Exchange Act (17 CFR 240.14a-12)

Pre-commencement communication pursuant to Rule 14d-2(b) under the Exchange Act (17 CFR 240.14d-2(b))

Pre-commencement communication pursuant to Rule 13e-4(c) under the Exchange Act (17 CFR 240.13e-4(c))

 

Securities registered pursuant to Section 12(b) of the Act:

 

Title of each class   Trading Symbol(s)   Name of each exchange on which registered
Common stock, par value $0.0001   STLN   The Nasdaq Stock Market LLC
Redeemable warrants, each whole warrant exercisable for one share of Common stock, each at an exercise price of $11.50 per share   TOIIW   The Nasdaq Stock Market LLC

 

 

Indicate by check mark whether the registrant is an emerging growth company as defined in Rule 405 of the Securities Act of 1933 (17 CFR §230.405) or Rule 12b-2 of the Securities Exchange Act of 1934 (17 CFR §240.12b-2).

 

Emerging growth company ¨

 

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☐.

 
 

 

 

Item 2.02. Results of Operations and Financial Condition

 

On August 6, 2026, Starling Oncology, Inc. (the "Company") issued a press release announcing its financial results for the three months ended June 30, 2026 and certain other financial information. A copy of the press release is furnished hereto as Exhibit 99.1, which is incorporated by reference herein. 

 

The information contained in Item 2.02 of this Current Report and Exhibit 99.1 is being furnished and shall not be deemed “filed” for purposes of Section 18 of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), or otherwise subject to the liabilities of such section.

 

Item 9.01 Financial Statements and Exhibits

 

(d) Exhibits

 

Exhibit No.     Description of Exhibit
99.1     Press release issued by Starling Oncology, Inc. on August 6, 2026
104     Cover Page Interactive Data File (embedded within the Inline XBRL document)

 

 

 

 

 

 
 

 SIGNATURE

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned hereunto duly authorized.

Dated: August 6, 2026 STARLING ONCOLOGY, INC.
   
  By: /s/ Robert Carter
  Name:   Robert Carter
  Title:

Chief Financial Officer

 

 

 

Exhibit 99.1

 

 

 

FOR IMMEDIATE RELEASE

 

Starling Oncology Reports Second Quarter 2026 Financial Results and Updates Full-Year 2026 Guidance

 

CERRITOS, Calif., August 6, 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 June 30, 2026 and updated it's full-year 2026 guidance.

 

Recent Operational Highlights

 

Specialty Pharmacy had record Part D fills driving Specialty Pharmacy revenue up 58% in the quarter as compared to prior year same quarter, driven by continued strength in prescription fill volumes as we bring new capitated lives onto the platform, along with the ongoing ramp of our Florida delegated arrangements.
Results in the first half of the year have given us the opportunity to raise guidance for revenue and gross profit.

Preparing to launch our proprietary provider portal, Starling Nexus, in mid-August which is designed to strengthen provider engagement and drive continued adherence to our clinical pathways, particularly for our network physicians.

Achieved exclusivity in California with one of our largest partners across all of their delegated medical groups, a relationship that was previously split with another entity. This added approximately 230,000 capitated lives.

 

Second Quarter 2026 Financial Highlights

 

All comparisons are to the quarter ended June 30, 2025 unless otherwise noted

 

Consolidated revenue of $161.3 million increased 34.6% from $119.8 million

Gross profit of $27.2 million, increased 55.2%

Net loss of $9.8 million compared to net loss of $17.0 million

Basic and diluted (loss) earnings per share of $(0.08) compared to $(0.15)

Adjusted EBITDA* of positive $229 thousand compared to $(4.1) million

Cash and cash equivalents of $41.1 million as of June 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 second quarter of 2026 was a milestone quarter for our company, with revenue up 35% year over year and Adjusted EBITDA turning positive in Q2. We signed our first delegated contracts outside of Florida, in Nevada and Oregon, and reached an exclusivity agreement with one of our largest partners across California. Both of these achievements will drive robust capitated revenue growth going forward. In mid-August, we are launching our new provider portal, Starling Oncology NexusTM, which we expect will deepen provider engagement and further support adherence to our clinical pathways. Given this momentum, we are raising our full-year outlook, and remain confident in our path to sustained positive Adjusted EBITDA as we move forward as Starling Oncology."

 

 

 
 

Updated Outlook for Fiscal Year 2026

 

  2026 Guidance - Previous 2026 Guidance - Updated
Revenue $630 to $650 million $650 to $670 million
Gross Profit $97 to $107 million $105 to $110 million
Adjusted EBITDA $0 to $9 million $2 to $7 million
Free Cash Flow $5 to $15 million Unchanged

 

* 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. In reliance on the unreasonable efforts exception provided under Regulation S-K, STLN is not reasonably able to provide a quantitative reconciliation for forward-looking information of Adjusted EBITDA, MLR and Free Cash flow to net (loss) income and net cash provided by operations, respectively, 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 $150 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 80% to 90% in the next twelve months.

 

Third Quarter of 2026 Outlook

 

For the third quarter of 2026, we anticipate Adjusted EBITDA of $500 thousand to $1.5 million, as the Company onboards and ramps our Florida delegated lives.

 

The outlook 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, August 6, 2026 at 5:30 p.m. (Eastern Time) to discuss second quarter results and management’s outlook for future financial and operational performance.

 

The conference call can be accessed live over the phone by dialing 1-800-225-9448, or for international callers, 1-203-518-9708. A replay will be available two hours after the call and can be accessed by dialing 1-844-512-2921, or for international callers, 1-412-317-6671. The passcode for the live call and the replay is 11161701. The replay will be available until Thursday, August 20, 2026.

.

About The Oncology Institute, 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 2.1 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

 

This press release includes contains 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 Q3 2026 outlook with respect to Adjusted EBITDA 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; the impact of a cybersecurity incident affecting a software provider on STLN’s business; and those factors discussed in the documents of 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, 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:

 

Medical Loss Ratio (MLR)
 
   Three Months Ended June 30,   Change 
(dollars in thousands)  2026   2025   $   % 
                 
Direct costs - patient services  $56,771   $51,150   $5,621    11.0%
Direct costs - fee-for-service   (32,860)   (37,769)   4,909    (13.0)%
Direct costs - capitated   23,911    13,381    10,530    78.7%
                     
Patient services revenue   58,827    55,891    2,936    5.3%
Fee-for-service revenue   (30,853)   (37,048)   6,195    (16.7)%
Capitated revenue   27,974    18,843    9,131    48.5%
                     
Medical loss ratio related to capitated contracts   85.5%   71.0%  $1,399    14.5%

 

 

Free Cash Flow Reconciliation
 
   Six Months Ended June 30,   Change 
(dollars in thousands)  2026   2025   $   % 
Net cash and cash equivalents provided by (used in) operating activities  $9,725   $(15,190)  $24,915    164.0%
Cash paid for interest   1,756    2,158    (402)   18.6%
Purchases of property and equipment   (1,950)   (1,536)   (414)   (27.0)%
Free Cash Flow  $9,531   $(14,568)  $24,099    165.4%

 

 

 
 

 

Adjusted EBITDA Reconciliation
 
   Three Months Ended June 30,   Change   Six Months Ended June 30,   Change 
(dollars in thousands)  2026   2025   $   %   2026   2025   $   % 
Net loss  $(9,789)  $(17,009)  $7,220    42.4%  $(12,281)  $(36,594)  $24,313    66.4%
Depreciation and amortization   1,838    1,805    33    1.8%  $3,454   $3,589    (135)   (3.8)%
Interest expense, net   1,859    1,870    (11)   (0.6)%  $3,793   $7,440    (3,647)   (49.0)%
Income tax and other taxes   86    (61)   147    %  $129   $(61)   190    %
Non-cash addbacks   (36)   2,222    (2,258)   (101.6)%  $(284)  $2,059    (2,343)   (113.8)%
Share-based compensation   1,070    752    318    42.3%  $2,756   $2,210    546    24.7%
Changes in fair value of liabilities   3,237    4,040    (803)   (19.9)%   (1,927)   7,392    (9,319)   (126.1)%
Unrealized loss on investments               %       6    (6)   (100.0)%
Post-combination compensation expense       13    (13)   (100.0)%       26    (26)   (100.0)%
Consulting fees   1,814    506    1,308    258.5%   2,087    839    1,248    148.7%
Infrastructure and workforce costs   150    1,771    (1,621)   (91.5)%   64    3,895    (3,831)   (98.4)%
Transaction costs       1    (1)   %       1    (1)   (100.0)%
Adjusted EBITDA  $229   $(4,090)  $4,319    105.6%  $(2,209)  $(9,198)  $6,988    76.0%

 

 

Key Business Metrics
 
   Three Months Ended June 30, 
(dollars in thousands)  2026   2025 
Affiliated and Network Clinics (1)   301    80 
Markets   17    20 
Lives under value-based contracts (millions)   2.1    1.9 
   
(1)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)

 

   June 30, 2026   December 31, 2025 
Assets          
Current assets:          
Cash and cash equivalents  $41,094   $33,565 
Accounts receivable, net   66,349    58,998 
Other receivables   360    322 
Inventories   20,011    16,875 
Prepaid expenses and other current assets   1,176    2,987 
Total current assets   128,990    112,747 
Property and equipment, net   10,583    10,684 
Operating right of use assets   21,188    22,374 
Intangible assets, net   9,585    11,015 
Goodwill   7,230    7,230 
Other assets   657    606 
Total assets  $178,233   $164,656 
Liabilities and stockholders’ deficit          
Current liabilities:          
Accounts payable  $60,279   $43,167 
Current portion of operating lease liabilities   7,225    7,156 
Accrued expenses and other current liabilities   27,435    20,639 
Total current liabilities   94,939    70,962 
Operating lease liabilities   17,384    19,131 
Derivative warrant liabilities   89    264 
Derivative liabilities   10,838    12,591 
Long-term debt, net of unamortized debt issuance costs   79,867    77,400 
Other non-current liabilities   30    28 
Total liabilities   203,147    180,376 
Stockholders’ deficit:          
Common Stock, 0.0001 par value, authorized 500,000,000 shares; 102,202,753 and 100,468,979 shares issued and outstanding at June 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 June 30, 2026 and 193,507 shares issued and outstanding at December 31, 2025        
Additional paid-in capital   259,795    256,708 
Treasury Stock at cost, 1,733,774 shares at June 30, 2026 and December 31, 2025   (1,019)   (1,019)
Accumulated deficit   (283,700)   (271,419)
Total stockholders’ deficit   (24,914)   (15,720)
Total liabilities and stockholders’ deficit  $178,233   $164,656 

 

 

 
 

Consolidated Statements of Operations (Unaudited)

(in thousands except share data)

 

   Three Months Ended June 30,   Six Months Ended June 30, 
   2026   2025   2026   2025 
Revenue                
Patient services  $58,827   $55,891   $117,914   $108,959 
Specialty Pharmacy   98,608    62,573    186,149    111,866 
Clinical trials & other   3,847    1,338    4,660    3,383 
Total operating revenue   161,282    119,802    308,723    224,208 
Operating expenses                    
Direct costs – patient services   56,771    51,150    110,154    98,230 
Direct costs – specialty pharmacy   77,346    51,086    148,089    90,949 
Direct costs – clinical trials & other      65        279 
Selling, general and administrative expense   29,943    26,907    58,155    52,283 
Depreciation and amortization   1,838    1,805    3,454    3,589 
Total operating expenses   165,898    131,013    319,852    245,330 
Loss from operations   (4,616)   (11,211)   (11,129)   (21,122)
Other non-operating expense (income)                    
Interest expense, net   1,859    1,870    3,793    7,440 
Change in fair value of derivative warrant liabilities   (6)   53    (174)   96 
Change in fair value of conversion option derivative liabilities   3,243    3,987    (1,753)   7,296 
Other, net   77    19    (714)   771 
Total other non-operating expense (income)   5,173    5,929    1,152    15,603 
Loss before provision for income taxes   (9,789)   (17,140)   (12,281)   (36,725)
Income tax benefit (expense)       131        131 
Net loss  $(9,789)  $(17,009)  $(12,281)  $(36,594)
Net loss attributable to common stockholders, basic and diluted  $(8,241)  $(13,991)  $(10,330)  $(30,072)
Net loss per share attributable to common stockholders:                    
Basic  $(0.08)  $(0.15)  $(0.10)  $(0.35)
Diluted  $(0.08)  $(0.15)  $(0.10)  $(0.35)
Weighted-average number of shares outstanding:                    
Basic   103,031,493    93,203,665    102,419,949    85,195,734 
Diluted   103,031,493    93,203,665    102,419,949    85,195,734 

 

 

 
 

Consolidated Statements of Cash Flows (Unaudited)

(in thousands)

 

   Six Months Ended June 30, 
   2026   2025 
Cash flows from operating activities:          
Net loss  $(12,281)  $(36,594)
Adjustments to reconcile net loss to cash and cash equivalents used in operating activities:          
Depreciation and amortization   3,454    3,589 
Amortization of debt issuance costs and debt discount   2,467    6,003 
Write-off of assets from clinical trials segment       2,398 
Share-based compensation   2,756    2,210 
Change in fair value of liability classified warrants   (174)   96 
Change in fair value of liability classified conversion option derivatives   (1,753)   7,296 
Deferred taxes       (32)
Loss on disposal of property and equipment   28     
Changes in operating assets and liabilities:          
Accounts receivable   (7,351)   (8,969)
Other receivables   (38)   (228)
Inventories   (3,136)   (5,747)
Prepaid expenses   1,811    1,250 
Other assets   (51)   3 
Accounts payable   17,112    11,490 
Change in operating leases   (492)   (120)
Accrued expenses and other current liabilities   7,353    2,262 
Other non-current liabilities   20    (97)
Net cash and cash equivalents provided by (used in) operating activities   9,725    (15,190)
Cash flows from investing activities:          
Purchases of property and equipment   (1,950)   (1,536)
Proceeds from asset disposition       126 
Net cash and cash equivalents used in investing activities   (1,950)   (1,410)
Cash flows from financing activities:          
Proceeds from private placement, net of offering costs       15,359 
Proceeds from employee stock purchase plan   220     
Payments made for financing of insurance payments   (560)   (456)
Principal payments on long-term debt       (20,000)
Principal payments on financing leases   (17)   (20)
Common stock issued for options exercised   111    2,340 
Net cash and cash equivalents provided by (used in) financing activities   (246)   (2,777)
Net increase (decrease) in cash and cash equivalents   7,529    (19,377)
Cash and cash equivalents at beginning of period   33,565    49,669 
Cash and cash equivalents at end of period  $41,094   $30,292 

 

Contacts

 

Media

 

The Oncology Institute, Inc.

Daniel Virnich, MD

danielvirnich@starlingoncology.com

(562) 735-3226 x 81125

 

Investors

 

ICR Strategic Communications

investors@icrinc.com

 

Filing Exhibits & Attachments

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