Over the past years, immune checkpoint inhibition has caused a dramatic therapeutic shift in the first-line treatment of patients with extensive-stage small cell lung cancer (ES-SCLC). After more than three decades without meaningful improvements in the treatment paradigm for these patients, combinations of platinum-etoposide with either durvalumab, or atezolizumab finally resulted in improved survival outcomes. Notwithstanding the convincing results with these innovative regimens in their respective clinical trials, real-world data on the safety and efficacy of chemo-immunotherapy in patients with ES-SCLC are still relatively scarce. Reassuringly, however, all the available data continue to point towards a clinical benefit of PD-L1 inhibitors in combination with platinum-etoposide vs. chemotherapy alone in this setting. Importantly, this benefit was also observed in patients who would not have been eligible for the pivotal clinical trials evaluating these regimens, including patients with a poor performance status.