In a female patient in her 50s with ovarian cancer who developed a whole-body rash and lip swelling 7 days after her first cycle of carboplatin, paclitaxel, and bevacizumab, how would you proceed with pretreatment for cycle 2, assuming this was a delayed reaction to carboplatin or paclitaxel?

It is very important to characterize any delayed rash after treatment with its timing, morphology, severity, and whether features of a severe cutaneous adverse reaction are present. A benign delayed rash is the most common scenario and can generally be treated with symptomatic management and enhanced premedications. But severe T-cell–mediated reactions (like SJS/TEN, DRESS) are contraindications to a rechallenge.

The key distinction is between:

1. Benign delayed rash, typically diffuse maculopapular rash appearing hours to days after infusion, without mucosal involvement, systemic symptoms, or lab abnormalities; this appears to be the most common delayed cutaneous reaction to chemotherapy.
2. Severe cutaneous adverse drug reactions such as SJS/T...