You are using an outdated browser. We suggest you update your browser for a better experience. Click here for update.
Close this notification.
Skip to main content Skip to search

Effectuez un dépistage du virus de l'hépatite B chez tous les patients cancéreux débutant un traitement systémique. Apprenez-en davantage sur le dépistage et la gestion du virus de l'hépatite B.

Certaines de ces informations ou toutes, dans certains cas, n’apparaissent qu’en Anglais. Vous pouvez demander la version française

Les renseignements du Formulaire de médicaments s’adressent aux professionnels de la santé. Il ne s’agit pas d’un avis médical. Certains des renseignements, y compris ceux sur le financement des médicaments anticancéreux, ne s’appliquent pas à tous les patients. Les plans de traitement du cancer sont propres à chaque patient. Si vous êtes un patient, veuillez parler avec votre équipe soignante pour comprendre comment ces renseignements s’appliquent à vous.

A - Drug Name

amivantamab

COMMON TRADE NAME(S):   Rybrevant®

 
B - Mechanism of Action and Pharmacokinetics

Amivantamab is a human, IgG1 bispecific antibody that targets both the epidermal growth factor receptor (EGFR) and mesenchymal-epithelial transition (MET). By binding to the extracellular domains of the EGFR and MET receptors, amivantamab disrupts signaling by blocking ligand binding and leads to degradation of EGFR and MET. The presence of EGFR and MET on the tumour cell surface also allows for targeted cell destruction by immune effector cells (e.g. natural killer cells, macrophages) via antibody-dependent cellular cytotoxicity and trogocytosis mechanisms. 



Absorption

AUC increased proportionally over a dose range from 350 - 1750 mg.

Time to reach steady state

13 weeks (for both 3- and 2-week dosing regimens)

T max

4.1 h (1050 mg dose)

5.7 h (1400 mg dose)


Distribution

Volume of distribution increased with increasing body weight; exposures were 30 - 40% lower in patients who weighed ≥ 80 kg compared to those < 80 kg, when receiving the same dose. 

Cross blood brain barrier?

Unknown

Metabolism

Expected to be metabolized into small peptides by catabolic pathways. 

Elimination

Clearance increased with increasing body weight. 

Half-life

13.7 days

 
C - Indications and Status
Health Canada Approvals:

  • Non-small cell lung cancer (NSCLC)

(Includes conditional approvals)

Refer to the product monograph for a full list and details of approved indications. 



 
D - Adverse Effects

Emetogenic Potential:  

Low

The following table lists adverse effects that occurred in ≥ 5% of patients treated with amivantamab monotherapy in a Phase 1 trial of previously treated NSCLC patients with EGFR Exon 20 insertion mutation. It also includes severe or life-threatening adverse effects from other sources or post-marketing. Incidences denoted with “†” were reported from Phase 3 studies of amivantamab in combination with carboplatin and pemetrexed.

ORGAN SITE SIDE EFFECT* (%) ONSET**
Cardiovascular Venous thromboembolism (8%) (3% severe) (including PE and DVT) † D
Dermatological Dry skin (16%) (including eczema) E
Paronychia (50%) (3% severe) E
Rash, pruritus (82%) (4% severe) (including acne, dermatitis, acneiform, hand-foot syndrome, maculopapular and papular) E
Toxic epidermal necrolysis (rare) D
Gastrointestinal Anorexia (15%) E
Constipation (23%) E
Diarrhea (15%) (3% severe) E
Mucositis (26%) (<1% severe) E
Nausea, vomiting (24%) E
General Edema (26%) E
Fatigue (33%) E
Hepatobiliary ↓ albumin (33%) E  D
↑ LFTs (17%) E  D
Hypersensitivity Infusion related reaction (64%) (3% severe) I
Infection Infection (8%) (pneumonia) E
Metabolic / Endocrine Abnormal electrolyte(s) (21%) (↓ K, ↓ Ca, ↓ Mg, ↓ Na) † E
Musculoskeletal Musculoskeletal pain (45%) (mild to moderate) E
Nervous System Dizziness (10%) E
Headache (6%) E
Peripheral neuropathy (9%) E
Ophthalmic Eye disorders (13%) E
Respiratory Cough, dyspnea (19%) E
Interstitial lung disease (3%) (1% severe) † D


* "Incidence" may refer to an absolute value or the higher value from a reported range.
"Rare" may refer to events with < 1% incidence, reported in post-marketing, phase 1 studies,
isolated data or anecdotal reports.

** I = immediate (onset in hours to days)     E = early (days to weeks)
D = delayed (weeks to months)      L = late (months to years)

The most common side effects for amivantamab include rash, pruritus, infusion related reaction, paronychia, musculoskeletal pain, ↓ albumin, fatigue, edema, mucositis, nausea, vomiting and constipation.

Infusion-related reactions (IRR) occurred commonly with amivantamab treatment, and included chills, nausea or vomiting, dyspnea, flushing, chest discomfort and hypotension. IRR onset was approximately 1 hour after start of infusion (range 0.1 to 18 hours). The majority of reactions occurred with the first infusion (65%) and were mild (Grade 1 or 2) in severity (97%). The incidence of IRR was significantly reduced with subsequent doses, with only 3% of patients experiencing an IRR with Day 2 infusion and <1% with subsequent infusions. In addition to administering premedications, the initial amivantamab infusion should be split over 2 days and cycle 1 doses administered via peripheral line to reduce incidence of IRR. 

Ocular toxicity, including keratitis (1%), occurred in patients treated with amivantamab both as monotherapy and in combination with carboplatin and pemetrexed or lazertinib. All events in the clinical trials were grade 1 or 2, except when in combination with lazertinib (<1% Grade 3 or 4). Reported toxicities included dry eye, blurred vision, pruritus, increased lacrimation, visual impairment, unusual eyelash growth and uveitis. Ophthalmologist consult is recommended for patients with ocular toxicities. 

Skin toxicity, including nail reactions, has been reported in patients treated with amivantamab monotherapy or combination treatment. Rash, pruritus and dry skin, mostly grade 1 or 2, have occurred and sometimes lead to dose reduction or discontinuation. Rash generally developed within the first 4 weeks of treatment (Cycle 1), with a median onset of 14 days. Paronychia events were mostly Grade 1 or 2 (1% Grade 3). Sun exposure should be limited and patients should be advised to use sunscreen and protective clothing during and for the first 2 months after treatment. Topical steroids, antibiotics and/ or dermatologic consults may be required.

Interstitial lung disease (ILD) has been reported in 2 -3% of patients treated with amivantamab, with 1% of patients discontinuing treatment due to ILD/pneumonitis. Patients should be monitored for symptoms of ILD/pneumonitis (e.g., dyspnea, cough, fever) and managed appropriately, if confirmed. 

Venous thromboembolic (VTE) events have occurred with amivantamab, mostly in combination with lazertinib, including fatal cases. In one clinical trial (MARIPOSA), VTEs occurred in 36% of patients that received this combination (10% Grade 3 and <1% Grade 4). During the course of the trial, 1% of patients experienced a VTE while receiving anticoagulants. The majority of events occurred during the first 4 months of treatment (median time to onset 84 days), so prophylactic anticoagulation is recommended for the first 4 months of treatment, when given in this combination. 

 
E - Dosing

Refer to protocol by which patient is being treated. 

EGFR Exon 19 deletion, Exon 21 L858R substitution, or Exon 20 insertion mutation should be confirmed using a validated test, prior to starting treatment with amivantamab.

Screen for hepatitis B virus in all cancer patients starting systemic treatment. Refer to the hepatitis B virus screening and management guideline.

 

Premedications (prophylaxis for infusion reaction):

Cycle 1, Day -1 to 0:

  • Dexamethasone 8 mg PO BID

Cycle 1, Day 1:

  • Dexamethasone 8 mg PO, AND
  • Dexamethasone 20 mg IV (or equivalent) 60 minutes pre-infusion
  • Acetaminophen 650 to 1000 mg IV/ PO 30 minutes pre-infusion
  • Diphenhydramine 25 to 50 mg IV/ PO (or equivalent) 30 minutes pre-infusion

Cycle 1, Day 2:

  • Dexamethasone 10 mg IV (or equivalent) 45 to 60 minutes pre-infusion
  • Acetaminophen 650 to 1000 mg IV/ PO 30 minutes pre-infusion
  • Diphenhydramine 25 to 50 mg IV/ PO (or equivalent) 30 minutes pre-infusion

Subsequent Doses:

  • Acetaminophen 650 to 1000 mg IV/ PO 30 minutes pre-infusion
  • Diphenhydramine 25 to 50 mg IV/ PO (or equivalent) 30 minutes pre-infusion
  • (Optional) Dexamethasone 10 mg IV (or equivalent) 45 to 60 minutes pre-infusion

 

Other Supportive Care:

  • Sun exposure may exacerbate skin reactions; patients should limit sun exposure during and for 2 months after treatment, use protective clothing and broad spectrum sunscreen (UVA, UVB) with SPF ≥ 30.
  • Alcohol- and fragrance-free emollient cream for skin and nail moisturization while on treatment and for 2 months after treatment ends.
  • Consider antibiotic prophylaxis for rash prevention.
  • Refer to EGFR inhibitor-induced skin toxicity management guidelines for more information (e.g. Alberta Health Services, ESMO, NCCN).


Adults:

In combination with carboplatin and pemetrexed*:

Each cycle is 3 weeks

< 80 kg at baseline:

  • Cycle 1:
    • 350 mg IV Day 1
    • 1050 mg IV Day 2 (total 1400 mg split over 2 days)
    • 1400 mg IV Day 8 and 15
  • Cycle 2: 1400 mg IV Day 1
  • Cycle 3 and beyond: 1750 mg IV Day 1, Q3 weeks

≥ 80 kg at baseline:

  • Cycle 1:
    • 350 mg Day 1
    • 1400 mg Day 2 (total 1750 mg split over 2 days)
    • 1750 mg IV Day 8 and 15
  • Cycle 2: 1750 mg IV Day 1
  • Cycle 3 and beyond: 2100 mg IV Day 1, Q3 weeks

Refer to related regimen monographs for more information, including carboplatin and pemetrexed dosing.

Other combination regimens and dosing schedules exist. Refer to the product monograph or related regimen monographs for details. 

 

Monotherapy*:

< 80 kg at baseline:

  • 1050 mg IV weekly x 4 weeks (split infusion on Day 1 & 2 of Week 1), then
  • 1050 mg IV Q2 weeks, starting Week 5

≥ 80 kg at baseline:

  • 1400 mg IV weekly x 4 weeks (split infusion on Day 1 & 2 of Week 1), then
  • 1400 mg IV Q2 weeks, starting Week 5

 

*Note: dose adjustments for subsequent body weight changes are not required.


Dosage with Toxicity:

Table 1 - Dose Levels

Dose Level Amivantamab Dose (mg)
0 1050 1400 1750 2100
-1 700 1050 1400 1750
-2 350 700 1050 1400
-3 Discontinue

 

Table 2 - Toxicity Management

Toxicity Severity/ Grade Action
Skin and naila  Grade 2

If no improvement after 2 weeks of supportive care (e.g. topical corticosteroids and topical and/or oral antibiotics), consider ↓ dose (Table 1).b

Grade 3

Hold until ≤ Grade 2.b

Resume at ↓ dose (Table 1).

If no improvement in 2 weeks, permanently discontinue.

Grade 4, severe bullous, blistering, or exfoliating skin conditions
(including TEN)

Permanently discontinue.
ILD/ Pneumonitis Any

Hold if suspected. Permanently discontinue if confirmed.

Other toxicityc Grade 3

Hold until ≤ Grade 1 or baseline.

  • If recovery ≤ 1 week, resume at same dose.
  • If recovery > 1 week, resume at ↓ dose (Table 1).

If no recovery after 4 weeks, permanently discontinue.

Grade 4

Hold until ≤ Grade 1 or baseline.

If recovery ≤ 4 weeks, resume at ↓ dose (Table 1).

If no recovery after 4 weeks, permanently discontinue.

If Grade 4 recurs, permanently discontinue.

aPatients should be referred to a dermatologist if rash is severe, presents with atypical appearance/distribution or lack of improvement within 2 weeks.

bAdminister systemic antibiotics and oral steroids as clinically indicated. Consider dermatologic consult.

cPatients with worsening eye symptoms should be referred promptly to an ophthalmologist. Contact lenses should be discontinued.

 

 

Table 3 - Management of Infusion-related Reactions (IRR):

Also refer to the CCO guideline for detailed description of Management of Cancer Medication-Related Infusion Reactions.
 

Grade Management Re-challenge
1 or 2
  • Stop the infusion.
  • Manage the symptoms (e.g., additional glucocorticoids, antihistamine, antipyretics and antiemetics).

Restart:

  • Restart the infusion at 50% of the rate at which the IRR occurred.
  • If there are no additional symptoms, the rate may be increased (see Table 4 and 5).
  • Administer pre-medications prior to next infusion.
3
  • Stop the infusion.
  • Manage the symptoms (e.g., additional glucocorticoids, antihistamine, antipyretics and antiemetics).

Restart:

  • Restart the infusion at 50% of the rate at which the IRR occurred.
  • If there are no additional symptoms, the rate may be increased (see Table 4 and 5).
  • If Grade 3 IRR recurs, stop infusion and do not restart (discontinue permanently).
  • Administer pre-medications prior to next infusion.
  • If Grade 3 IRR recurs, discontinue permanently (do not re-challenge). 
4
  • Stop the infusion.
  • Aggressively manage symptoms.
  • Discontinue permanently (do not re-challenge).


Dosage with Hepatic Impairment:

Total bilirubin   AST Amivantamab Dose
≤ ULN and > ULN No dose adjustment required
≤ 1.5 x ULN and  Any
>1.5 to 3 x ULN and  Any No data available
> 3 x ULN and Any

 



Dosage with Renal Impairment:

Creatinine Clearance (mL/min) Amivantamab Dose
≥ 29 No dose adjustment required
< 29 No data available

 



Dosage in the elderly:

No dose adjustment is required in patients aged 65 years or older. No clinically relevant differences in effectiveness were observed based on age, however there was a higher incidence of adverse effects in patients 65 years or older compared to younger patients, in clinical trials. 



Dosage based on gender:

No clinically significant differences were observed based on gender, however, amivantamab clearance was higher in males compared to females and exposure of amivantamab was 35% higher in women than men at steady state according to PK analysis.



Children:

The safety and efficacy of amivantamab have not been established in pediatric patients. 



 
F - Administration Guidelines
  • Dilute in 5% dextrose (D5W) or 0.9% sodium chloride (NS) to a final volume of 250 mL. Mix by gentle inversion; do not shake.

  • Compatible with polyvinylchloride (PVC), polypropylene (PP), polyethylene (PE), or polyolefin blend (PP+PE) infusion bags, and polyurethane (PU), polybutadiene (PBD), PVC, PP, or PE infusion sets. 

  • Administer by IV infusion using sterile, non-pyrogenic, low protein-binding 0.2 micron polyethersulfone in-line filter, primed with diluent. See Tables 4 & 5 for infusion rates.

  • Infuse via peripheral line for all Cycle 1 doses (Weeks 1 to 4) to minimize IRR (unless medically acceptable to use central line after Week 2). Administration via central line may be considered for subsequent doses. 

  • When chemotherapy is given on the same day administer pemetrexed first, carboplatin second, and amivantamab last. 

  • Do not co-administer other drugs through the same infusion line.

  • Store unopened vials refrigerated (2°C to 8°C) and protect from light.

​​​​​Also refer to the CCO guideline for detailed description of Management of Cancer Medication-Related Infusion Reactions.

 

 Table 4 - Infusion rates for amivantamab in combination with chemotherapy

Weeka Cycle Body weight Dose  Total volume Initial infusion rate Subsequent infusion rateb
1 Cycle 1, Day 1 (split dose) Any 350 mg 250 mL 50 mL/hr 75 mL/hr
1

Cycle 1, Day 2 (split dose)

< 80kg 1050 mg 250 mL 33 mL/hr 50 mL/hr
≥ 80kg 1400 mg 250 mL 25 mL/hr 50 mL/hr
2 Cycle 1, Day 8 < 80kg 1400 mg 250 mL 65 mL/hr N/A
≥ 80kg 1750 mg 250 mL
3 Cycle 1, Day 15 < 80kg 1400 mg 250 mL 85 mL/hr N/A
≥ 80kg 1750 mg 250 mL
4 Cycle 2, Day 1 < 80kg 1400 mg 250 mL 125 mL/hr N/A
≥ 80kg 1750 mg 250 mL
7 + Cycle 3, Day 1 and subsequent doses < 80kg 1750 mg 250 mL 125 mL/hr N/A
≥ 80kg 2100 mg 250 mL

aDosing is every 3 weeks starting Week 7.
bIncrease initial infusion rate after 2 hours if no IRR.

 

Table 5 - Infusion rates for monotherapy

Weeka Cycle Body weight Dose  Total volume Initial infusion rate Subsequent infusion rateb
1 Cycle 1, Day 1 (split dose) Any 350 mg 250 mL 50 mL/hr 75 mL/hr
1

Cycle 1, Day 2 (split dose)

< 80kg 700 mg 250 mL 50 mL/hr 75 mL/hr
≥ 80kg 1050 mg 250 mL 35 mL/hr 50 mL/hr
2 Cycle 1, Day 8 < 80kg 1050 mg 250 mL 85 mL/hr N/A
≥ 80kg 1400 mg 250 mL 65 mL/hr
3 Cycle 1, Day 15 < 80kg 1050 mg 250 mL 125 mL/hr N/A
≥ 80kg 1400 mg 250 mL 85 mL/hr
4 Cycle 1, Day 22 < 80kg 1050 mg 250 mL 125 mL/hr N/A
≥ 80kg 1400 mg 250 mL
5 + Cycle 2, Day 1 and subsequent doses < 80kg 1050 mg 250 mL 125 mL/hr N/A
≥ 80kg 1400 mg 250 mL

aDosing is every 2 weeks starting Week 5.
bIncrease initial infusion rate after 2 hours if no IRR.

 
G - Special Precautions
Contraindications:

  • Patients who are hypersensitive to this drug or to any of its components.

Other Warnings/Precautions:

  • Patients with active interstitial lung disease/ pneumonitis should not receive amivantamab.
  • Caution in patients with a history of thrombotic events receiving amivantamab in combination with lazertinib. VTE occurred in trials with this combination, in some cases despite prophylactic anticoagulation.

  • Blurred vision and visual impairment have been observed; caution is required when driving or operating machinery. 


Other Drug Properties:

  • Carcinogenicity: No information available
    • No formal studies, however antibodies are large proteins and cannot diffuse into cells and therefore cannot interact with DNA or chromosomal material.

Pregnancy and Lactation:
  • Fetotoxicity: Documented in animals
    • EGFR and MET inhibitors have resulted in higher incidence of embryo-fetal development impairment, embryolethality and abortion in animal studies. 
       
  • Embryotoxicity: Documented in animals

     

     

  • Pregnancy:
    • Amivantamab is not recommended for use in pregnancy. Adequate contraception should be used by patients and their partners during treatment, and for 3 months after the last dose.

    • Patients should not donate sperm during treatment, and for 3 months after the last dose.

     

  • Breastfeeding:

    Breastfeeding is not recommended during treatment and for 3 months after the last dose.
     

  • Excretion into breast milk:
    • Human IgGs are known to be excreted into breast milk during the first few days after birth, with decreasing concentrations soon afterwards. Amivantamab is a human IgG1 bispecific antibody and therefore has potential to harm breast-fed infants.

     

  • Fertility effects: No information available
 
H - Interactions

No known drug interactions as no formal drug interaction studies have been conducted. 

 
I - Recommended Clinical Monitoring

Treating physicians may decide to monitor more or less frequently for individual patients but should always consider recommendations from the product monograph.

Refer to the hepatitis B virus screening and management guideline for monitoring during and after treatment.
 

Recommended Clinical Monitoring

Monitor Type Monitor Frequency

CBC

Baseline and before each cycle

Electrolytes, including magnesium, potassium and calcium

Baseline and before each cycle

Renal function tests

Baseline and before each cycle

Liver function tests

Baseline and before each cycle

Clinical toxicity assessment for infusion-related reactions, venous thromboembolic events, dermatologic (including nail), ocular, respiratory and GI toxicity

At each visit


Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version



 
K - References

Amivantamab: Drug information. Waltham, MA: Lexi-Comp Inc., 2025. https://online.lexi.com. Accessed October 6, 2025.

Amivantamab (Rybrevant). Prescribing information. Janssen Biotech Inc. (USA), October 8, 2025.

Amivantamab (Rybrevant) Product monograph. Janssen Inc., November 4, 2025.

Burtness B, Anadkat M, Basti S, et al. NCCN Task Force Report: Management of dermatologic and other toxicities associated with EGFR inhibition in patients with cancer. J Natl Compr Canc Netw. 2009;7 Suppl 1:S5-S24.

Canada’s Drug Agency. Reimbursement Recommendation Amivantamab (Rybrevant). Canadian Journal of Health Technologies. September 2025; 5 (9).

Canada’s Drug Agency. Reimbursement Recommendation Amivantamab (Rybrevant). Canadian Journal of Health Technologies. January 2025; 5 (1).

Lacouture ME, Sibaud V, Gerber PA, et al. Prevention and management of dermatological toxicities related to anticancer agents: ESMO Clinical Practice Guidelines. Ann Oncol. 2021;32(2):157-170.

NCCN Practice Guidelines in Oncology (NCCN Guidelines) - Antiemesis v.2.2025. NCCN, May 12, 2025. Accessed October 2025.

Park K, Haura EB, Leighl NB, et al. Amivantamab in EGFR exon 20 insertion-mutated non-small-cell lung cancer progressing on platinum chemotherapy: initial results from the CHRYSALIS phase I study. J Clin Oncol 2021 Oct 20;39(30):3391-402.

Passaro A, Wang J, Wang Y, et al. Amivantamab plus chemotherapy with and without lazertinib in EGFR-mutant advanced NSCLC after disease progression on osimertinib: primary results from the phase III MARIPOSA-2 study. Ann Oncol. 2024;35(1):77-90.

Protocol for: Passaro A, Wang J, Wang Y, et al. Amivantamab plus chemotherapy with and without lazertinib in EGFR-mutant advanced NSCLC after disease progression on osimertinib: primary results from the phase III MARIPOSA-2 study. Ann Oncol. 2024;35(1):77-90.

Protocol for: Zhou C, Tang KJ, Cho BC, et al. Amivantamab plus Chemotherapy in NSCLC with EGFR Exon 20 Insertions. N Engl J Med 2023 Nov 30;389(22):2039-51.

Prevention and Treatment of Acneiform Rash in Patients Treated with EGFR Inhibitor Therapies. Alberta Health Services. November 2020; 3(2).

Zhou C, Tang KJ, Cho BC, et al. Amivantamab plus Chemotherapy in NSCLC with EGFR Exon 20 Insertions. N Engl J Med 2023 Nov 30;389(22):2039-51.

 


November 2025 New drug monograph

 
L - Disclaimer

Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.
The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.
The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.
Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.
While care has been taken in the preparation of the information contained in the Formulary, such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability.
CCO and the Formulary’s content providers shall have no liability, whether direct, indirect, consequential, contingent, special, or incidental, related to or arising from the information in the Formulary or its use thereof, whether based on breach of contract or tort (including negligence), and even if advised of the possibility thereof. Anyone using the information in the Formulary does so at his or her own risk, and by using such information, agrees to indemnify CCO and its content providers from any and all liability, loss, damages, costs and expenses (including legal fees and expenses) arising from such person’s use of the information in the Formulary.