Breast cancer is a serious health problem in the elderly female population. The approach to treating healthy women aged 65–70 years should be similar to treating younger patients with a similar stage and biological subtype of breast cancer. Greater individualization of treatment is necessary in the case of patients with worse parameters of functional efficiency and features of the frail syndrome. It should also be emphasized the need for closer cooperation with geriatricians, especially when defining the management plan and conducting systemic treatment in this group of patients. There is also a great need for research into the proper selection of treatment in elderly breast cancer patients. This is especially important in groups of patients with early and locally advanced breast cancer.

Alpelisib is an oral drug, a phosphatidylinositol 3 kinase inhibitor (PI3K) which plays a fundamental role in the cancer process. In May 2019 Alpelisib in combination with fulvestrant was approved by FDA in treatment of PIK3CA-mutated, hormone receptor-positive, human epidermal growth factor receptor-2-negative advanced breast cancer. Since 2020 the drug has also recommendation of European Medicines Agency (EMA). The following is a case of a patient with primary metastatic breast cancer who was treated with alpelisib in combination with fulvestrant after prior chemotherapy and an aromatase inhibitor with ribociclib, obtaining a significant clinical benefit.