For years interest in developing new treatment strategies in SCLC has lagged behind the efforts addressing NSCLC. This trend could easily be followed during the ASCO 2009 meeting. Fifty-two abstracts relating to SCLC were exhibited, whereas 392 abstracts covered NSCLC research topics. None of the presentations dealing with SCLC showed successful phase III results no results were presented in the lung cancer oral presentation session. We are left with efforts in challenging the first-line standard regimen of etoposide/platinum (EP) with the irinotecan/platinum (IP) regimen as an alternative treatment choice with comparable results but different toxicity. Randomised phase II results with amrubicin seem to support the use of second-line treatment in an otherwise chemo-resistant and desperate disease. In various trials most of the investigated new targeting agents did not lead to a reproducible improvement in the outcome of SCLC patients. After ASCO 2009 it seems that progress in the treatment of SCLC requires not only a tailored medical approach, which is difficult to achieve, but also changes in therapeutical strategies in radiotherapy and surgery for LD-SCLC.