Small cell lung cancer (SCLC) is a highly aggressive form of lung cancer, and chemotherapy plays a central role in its treatment. In recent years, there have been major advances in the treatment landscape for small cell lung cancer, notably the advent of immunotherapy. When paired with chemotherapy, immunotherapy—more especially, programmed cell death ligand 1 (PD-L1) inhibitors—has demonstrated encouraging outcomes in the frontline scenario for patients with extensive-stage small cell lung cancer. But even with these improvements, the majority of extensive-stage small cell lung cancer patients continue to have dismal outcomes, with the illness progressing even during maintenance immunotherapy. Future small cell lung cancer treatment directions include the development of combination techniques that overcome resistance mechanisms and tumor heterogeneity. Investigating advanced pharmaceutical combinations to improve treatment outcomes, such as combining immunotherapy or targeted therapy with chemotherapy is part of this.