Medpace reported Q1 2026 revenue of $706.6 million, a 26.5% increase year over year, with EBITDA rising 25.9% to $149.4 million and net income climbing 8.1% to $123.9 million. Net income per diluted share reached $4.28, operating cash flow was $151.8 million and cash balances totaled $652.7 million as of March 31, 2026.

Net new business awards for the quarter reached $618.4 million, a 23.7% year-over-year increase, while ending backlog stood at approximately $2.9 billion, up 2.9% from Q1 2025. These figures reflect continued demand but show only modest backlog growth relative to award wins.

Project cancellations climbed to their highest level in over a year, driving the net book-to-bill ratio down to 0.88, as RFP volume declined both sequentially and year over year. CEO August Troendle noted the cancellations were driven by project-specific issues like product performance and reprioritizations, particularly in oncology and cardiovascular programs.

High cancellation rates and limited backlog expansion raise questions about future revenue visibility, especially given a higher effective tax rate that weighed on net income growth. Biopharma M&A activity also poses a risk, as client acquisitions can divert ongoing work to other providers or internal teams.