Small cell lung cancer (SCLC) accounts for approximately 15% of lung cancers. The disease is defined by a close association with smoking, an aggressive nature, a rapid progression rate, and a strong tendency for metastasis. For decades, the standard first-line treatment for the disease was a combination of platinum and etoposide and various chemotherapeutics in the second-line treatment. Studies investigating the effectiveness of CPIs in the limited-stage are ongoing. Chemotherapy remains the mainstay of treatment in extensive-stage disease. Combining certain immunotherapy drugs called checkpoint inhibitors (CPI) with chemotherapy in first-line therapy has been shown to provide a significant survival benefit. It is a significant step forward that these agents have been shown to improve survival rates in the treatment of a disease that has not improved in decades. Anti-CTLA4 inhibitors have not been shown to be beneficial when added to therapy. Monotherapy with a CPI may be an option for certain patient groups receiving second-line or subsequent treatment for the disease. There is no biomarker to guide treatment selection. More recently, the studies on gene-signature analyzes obtained important results to determine the prognosis of the disease and treatment selection. While cytotoxic chemotherapy remains the cornerstone of disease management, great efforts to develop new agents, test novel combinations, and personalize treatment continue to be made in SCLC management.