How would you treat a newly metastatic ER+ PR+ HER2+ triple positive breast cancer with diffuse symptomatic disease and severe neuropathy from prior adjuvant paclitaxel?

This is a challenging clinical situation where the medical oncologist has to balance the need to rapidly induce a response to relieve the patient's symptoms and the risk of exacerbating the patient's peripheral neuropathy, which may be irreversible. Because of the latter concern, I would avoid standard first-line therapy for HER2+ MBC with a taxane, trastuzumab, and pertuzumab (based on the CLEOPATRA study), nor would I substitute a chemotherapeutic agent that could exacerbate peripheral neuropathy such as vinorelbine or eribulin, or administer single agent ado-trastuzumab emtansine. Options worth considering include administering a chemotherapeutic agent that is seldom associated with neuropathy, such as doxorubicin (which would be my pref...