Although initially extremely sensitive to many chemotherapeutic drugs and radiotherapy, ultimately small cell lung cancer (SCLC) is a progressive and fatal disease. Stage of disease is a major prognostic factor in the treatment of SCLC patients. Patients with limited stage disease have approximately a 10% chance of long-term (> 5 years) disease-free survival, whereas those with extensive stage disease are incurable with currently available therapy. In extensive stage disease, patients with a good performance status and younger than 65 years of age are ideal candidates for trials using intensive standard chemotherapy or experimental modalities; most patients, however, including those who are elderly and medically unfit, are best treated conservatively with single-agent etoposide. Various types of therapy, including intensive induction chemotherapy and consolidation regimens, have been unable to improve survival rates in extensive stage SCLC. Thus, until better treatments are developed, the goal of therapy for extensive stage SCLC should be adequate palliation and prolongation of quality survival.