Früh M, Panje CM, Reck M, et al. - Given short survival is usually seen in stage IV small cell lung cancer (SCLC) as well as frequent progression within months after first-line systemic therapy, researchers here examined the efficacy of topotecan, an approved second-line treatment. Performance status and the interval of recurrence since first-line treatment were found to be the most relevant factors after assessing the decision-making patterns for second line treatment of 13 European medical oncologists with expertise in SCLC. Cyclophosphamide, doxorubicin and vincristine (CAV) was recommended for fit patients with an interval of less than 3 months since the end of first-line chemotherapy by 62% of the experts and topotecan was recommended for unfit patients by 54% of the experts. There was a clear consensus for a re-challenge with a platinum doublet (92%) for an interval of more than 6 months. With an interval of 3–6 months since the end of first-line therapy, no consensus could be made on the second-line therapy. Findings suggest there may be differences in real world practice vs recommendations in general guidelines, since habits, patient’s preference, convenience or costs, and other real-world factors have to be considered.