Small cell lung cancer (SCLC) is a highly aggressive malignancy with dismal outcomes, representing around 15% of all lung cancers. It occurs almost exclusively in smokers and is characterized by rapid cellular proliferation, genomic instability, high tumor mutation burden, and a higher propensity for distant metastasis. It originates from neuroendocrine cells in the bronchial epithelium and almost always shows functional loss of tumor suppressor genes TP53 and RB1. Patients present with a short duration of illness and rapidly progressing symptoms. Up to 70% of patients present with distant metastasis at diagnosis, with common sites being the lung, brain, liver, adrenal, and bone. SCLC is characterized by high platinum sensitivity; however, responses are short-lived. The addition of immune checkpoint inhibitors to platinum-based chemotherapy has improved survival, though modestly. With recent advances in gene expression profiling and transcriptomics, various molecular subtypes of SCLC have been identified, which are opening up newer therapeutic avenues.