Polyscias fruticosa (L.) Harms is commonly used for medicinal purposes in Vietnam. In traditional medicine, the plant is used to cure ischemia, reduce inflammation, and increase cerebral blood circulation. Triterpene saponins are the major chemical constituents found in the roots of P. fruticosa. This compound exhibited a broad spectrum of biological effects, including lowering blood sugar, suppressing tumor growth and inflammation. This study focused on optimizing the process of total saponins extraction from P. fruticosa roots using the ultrasonic-assisted extraction (UAE) method, ethanol solvent and response surface methodology, and Box–Behnken design model, then evaluating the cytotoxic effect against some cancer cell lines. The results showed that under the optimal conditions, including an extraction temperature of 60 °C and ultrasonic power of 185 W in 65 min, the maximum extraction yield and total saponin content were 14.51 ± 1.15% and 41.24 ± 1.68 mg/g, respectively. Moreover, the saponin extract had cytotoxic effects against A549, HepG2, PC-3, and Hela. The results of this study confirmed that triterpene saponin is an important chemical component which is present in a high content in P. fruticosa roots and gives rise to significant biological activities. In addition, UAE can be used as a highly efficient method for triterpene saponins extraction from P. fruticosa roots.