Triple-negative breast carcinoma is known for its aggressive profile and the lack of hormonal or HER2 therapeutic targets. This subtype of tumor is particularly challenging to treat, especially in elderly patients, where tolerance to standard therapeutic regimens may be reduced and multiple comorbidities further complicate clinical management. In this scenario, sacituzumab govitecan (SG) is revolutionizing the therapeutic pathway by offering a particularly active treatment, especially in advanced forms resistant to conventional therapies, with a manageable toxicity profile and reassuring data on efficacy even in case of dose reductions. In this clinical case, we describe the use of SG in a 71-year-old patient diagnosed with metastatic breast cancer histologically shifted from luminal B to triple negative, who had already received numerous and varied hormonal and chemotherapeutic treatment lines. Despite the need for dose reduction due to G3 diarrhea, after 16 months of therapy, the patient continues treatment with minimal impact on quality of life and maintaining stability after a partial response of the disease.