Grail, Inc. · NASDAQ:GRAL
Grail — Technical Presentation (May 2026)
19 slides from Grail's technical presentation, May 26, 2026
Slide 1: NHS-Galleri: Primary Results From a Randomised Controlled Trial of an MCED Test
NHS-Galleri: Primary Results From a Randomised Controlled Trial to Assess the Clinical Utility of a Multi-Cancer Early Detection (MCED) Test in Population Screening Charles Swanton, Peter Johnson, Thomas Round, Jane Warwick, Helen Jones, Harpal Kumar, Wei Liang, Rebecca Smittenaar, Richard D. Neal,
Slide 2: Key Takeaways
2 Key Takeaways In the largest and first randomised controlled screening trial of an MCED test: Safety and Routes to Clinical Utility 1 Performance Diagnosis • Primary endpoint not met • Demonstrated safe • 4-fold increase in (stage III/IV reduction) implementation and robust screen-detected cancers
Slide 3: Most Cancer Diagnoses and Deaths Are From Types Without Guideline-Recommended Screening
3 Most Cancer Diagnoses and Deaths Are From Types Without Guideline-Recommended Population Screening Cancers detected through Cancer deaths not Stage IV cancers represented guideline-recommended addressed by current 18% of all estimated diagnoses, population screeninga screening implementation but c
Slide 4: Blood-Based Targeted Methylation MCED Test
4 Blood-Based Targeted Methylation MCED Test The MCED test detects a cancer signal from cell-free DNA (cfDNA) in blood and predicts cancer signal origin (CSO) to guide diagnostic evaluation Negative (No cancer signal detected) Positive (Cancer signal detected) Predicted CSOb Tumor sheds cfDNA Blood
Slide 5: NHS-Galleri Is the Largest, First, and Only Randomised Controlled Clinical Utility Trial of an MCED Test
5 NHS-Galleri Is the Largest, First, and Only Randomised Controlled Clinical Utility Trial of an MCED Test to Date MCED, multi-cancer early detection; NHS, National Health Service. a Lung, head & neck, colorectal, pancreas, myeloma/plasma cell neoplasm, liver/bile duct, stomach, esophagus, anus, lym
Slide 6: Trial Arms Were Well Balanced and Retained Majority of Participants Over 3 Screening Rounds
6 Trial Arms Were Well Balanced and Retained Majority of Participants Over 3 Screening Rounds Enrolment and Randomisation Baseline Demographics and Intervention Control Arm Over ~10.5 Months Characteristics Arm (n=71,122) (n=71,128) (Randomised Analysis Set) Median Age (IQR), years 66 (59, 71) 66 (5
Slide 7: No Significant Reduction in Stage III/IV Cancers Observed in the Intervention Arm
Primary Endpoint | 12 Prespecified Cancer Types a 7 No Significant Reduction in Stage III/IV Cancers Observed in the Intervention Arm With the Current Follow-Up Window 3%b Relative incidence of stage III/IV cancers decreased after the first screening round Incident Rounds Control 5.6% 11.9% Interven
Slide 8: No Significant Reduction in Stage III/IV Cancers Observed in the Intervention Arm
Primary Endpoint | 12 Prespecified Cancer Types a 8 No Significant Reduction in Stage III/IV Cancers Observed in the Intervention Arm With the Current Follow-Up Window 3%b Relative incidence of stage III/IV cancers decreased after the first screening round Prevalent Incident Rounds Control 19%b 5%b
Slide 9: No Significant Reduction in Stage III/IV Cancers Appears Driven by Increase in Stage III
Descriptive Summary | 12 Prespecified Cancer Types a 9 No Significant Reduction in Stage III/IV Cancers Appears to Be Driven by Increase in Stage III Cancers Diagnosed 3%b 25%c 14%c Control Intervention Incidence Rate Ratiod 1.03 (Intervention/Control) (95% CI, 0.92, 1.14) p=0.6324 a 12 prespecified
Slide 10: No Significant Reduction in Stage III/IV Cancers Observed in the Intervention Arm
Primary Endpoint | 12 Prespecified Cancer Types a 10 No Significant Reduction in Stage III/IV Cancers Observed in the Intervention Arm With the Current Follow-Up Window Relative incidence of stage III/IV cancers Cumulative Probability of Stage III/IV Cancer decreased after the first screening round
Slide 11: 14% Reduction in Stage IV Cancers Observed in the Intervention Arm
Secondary Endpoint | 12 Prespecified Cancer Typesa 11 14% Reduction in Stage IV Cancers Observed in the Intervention Arm; ≥22% Reduction in Incident Rounds Cumulative Probability of Stage IV Cancer Relative incidence of stage IV cancers decreased each screening round Intervention vs Control Stage IV
Slide 12: 11% Reduction in Stage IV Cancers Observed Across All Cancers in the Intervention Arm
Secondary Endpoint | All Routinely Staged Cancer Typesa 12 11% Reduction in Stage IV Cancers Observed Across All Cancers in the Intervention Arm; >20% Reduction in Incident Rounds Cumulative Probability of Stage IV Cancer Relative incidence of stage IV cancers decreased each screening round Interven
Slide 13: Differences in Stage IV Diagnoses by Cancer Types
13 Descriptive Summary | 12 Prespecified Cancer Typesa Differences in Stage IV Diagnoses by Cancer Types Liver/bile Bladder duct Oesophagus Head & neck Colorectum Lung Stomach Lymphoma Ovary Pancreas England Stage IV 5.8% 2.6% 6.2% 38.4% 11.0% 4.5% 4.5% 65.7% 16.2% 2.1% 5-year net Stage III 31.8% 13
Slide 14: Shift to Stage I-II Cancer Detection With MCED Screening Added to SOC
Descriptive Summary | 12 Prespecified Cancer Typesa 14 Shift to Stage I-II Cancerb Detection With MCED Screening Added to SOC After 3 Screening Rounds 16%c Control Intervention Relative Risk 1.16 (Intervention/ (95% CI, 1.03, 1.30) Control) +28.8% -3.8% -14.0% -4.0% +30.6% +21.7% +36.4% +92.3% +118.
Slide 15: Robust MCED Test Performance in UK Population
15 Secondary Endpoint | Intervention Arma Robust MCED Test Performance in UK Population Aggregate MCED Test Performance Over 3 Screening Roundsb Cancer Status Cancer No Cancer Performance Diagnosis Diagnosis Total Metric (95% CI) (n=3051) (n=194,095) (N=197,146) PPVc Positive 937 864 1801 52.0% CSO
Slide 16: The MCED Test Itself Was Safe When Implemented at Population Scale
Secondary Endpoint | Randomised Analysis Set 16 The MCED Test Itself Was Safe When Implemented at Population Scale 0.45% (321/71,128) and 0.52% (371/71,122) participants in the control and intervention arms, respectively, experienced a study-related AE collected from blood sample collection up to re
Slide 17: MCED Quadrupled Screening-Detected Cancers and Reduced Clinically Detected Cancers and Emergency Presentations
17 Exploratory | All Detected Cancers MCED Quadrupled the Number of Screening-Detected Cancers and Reduced Clinically Detected Cancers and Emergency Presentations 4x Screening-Detected Stage IV • 21% reduction in clinically detected cancersc MCED- Control vs Intervention: Stage III Detected 3110 vs
Slide 18: Key Takeaways
18 Key Takeaways In the largest and first randomised controlled screening trial of an MCED test: Safety and Routes to Clinical Utility Performance Diagnosis • Primary endpoint not met • Demonstrated safety, • 4-fold increase in screen- (stage III/IV reduction) PPV of 52%, and detected cancers specif
Slide 19: Acknowledgements
19 Acknowledgements Thank you to all that made this trial possible, including, but not limited to • Trial Participants and their Families • NHS England • Investigators • NHS Guys and St Thomas' Hospital Clinical Team • Trial Steering Committee • Cancer Alliances • Independent Data Monitoring • Natio