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Simple Summary  Small cell lung cancer (SCLC) continues to carry a poor prognosis with a five-year survival rate of 3.5% and a 10-year survival rate of 1.8%. The pathogenesis remains unclear, and there are no known predictive or diagnostic biomarkers. The current SCLC classification as a single entity hinders effective targeted therapies against this heterogeneous neoplasm. Despite dedicated decades of research and clinical trials, there has been no change in the SCLC treatment paradigm. This review summarizes the body of literature available on SCLC’s genomic landscape to describe SCLC’s molecular/genetic aspects, regardless of therapeutic strategy.    Abstract  Small cell lung cancer (SCLC) is a highly proliferative lung cancer that is not amenable to surgery in most cases due to the high metastatic potential. Precision medicine has not yet improved patients’ survival due to the lack of actionable mutations. Intra- and intertumoral heterogeneity allow the neoplasms to adapt to various microenvironments and treatments. Further studying this heterogeneous cancer might yield the discovery of actionable mutations. First-line SCLC treatment has added immunotherapy to its armamentarium. There has been renewed interest in SCLC, and numerous clinical trials are underway with novel therapeutic approaches. Understanding the molecular and genetic landscape of this heterogeneous and lethal disease will pave the way for novel drug development.

Small Cell Lung Cancer: State of the Art of the Molecular and Genetic Landscape and Novel Perspective