Extensive-stage small cell lung cancer (ES-SCLC) is characterized by rapid progression, a high risk of recurrence, and poor prognosis, and remains a major therapeutic challenge in lung cancer. In recent years, immune checkpoint inhibitors combined with Platinum-Etoposide chemotherapy have become the standard first-line treatment for ES-SCLC, driving a shift from conventional chemotherapy toward multimodal combination strategies and precision-guided patient stratification, while creating both new opportunities and challenges for further therapeutic improvement. Following the clinical treatment pathway, this review summarizes advances in multidisciplinary combination treatment for ES-SCLC, including chemotherapy, immunotherapy, targeted therapy, radiotherapy, and traditional Chinese medicine, with emphasis on standard regimens, maintenance therapy, clinical limitations, and emerging research directions. This review aimed to provide a reference for individualized treatment and comprehensive disease management of ES-SCLC in the era of precision medicine. .