AbstractBackgroundThe efficacy and toxicity profiles for extensive‐stage small cell lung cancer (ES‐SCLC) are unclear. We aimed to address this gap through a Bayesian network meta‐analysis.MethodsWe performed network analysis from randomized controlled trials comparing these treatments: PD‐(L)1 inhibitor, CTLA‐4 inhibitor, CXCR inhibitor, PARP inhibitor, CDK inhibitor, chemotherapy, and their combinations. Pooled estimations of progression‐free survival, overall survival, objective response rate, and toxicity (systematic and specific) were conducted within the Bayesian framework.ResultsTwenty‐five trials involving 9 strategies were included. In terms of progression‐free survival and overall survival, PD‐(L)1 inhibitor combined with cisplatin/carboplatin (P) and etoposide (E) shown the acknowledged superiority than other treatments. The addition of CTLA‐4 inhibitor (ipilimumab) to EP had the highest response rate among these regimens, and the combination of chemotherapy (irinotecan) and cisplatin/carboplatin had the greatest probability of performing considerable systematic security. The secondary endpoint was specific adverse events, including vomiting, fatigue, thrombocytopenia, constipation, and decreased appetite; hence we depicted the specific toxicity profile of each regimen. In addition, we identified the differences between PD‐1 inhibitors and PD‐L1 inhibitors in prolonging overall survival time for the central nervous system (CNS)/liver metastases patients.ConclusionsEP combined with PD‐(L)1 inhibitor followed by CTLA‐4 inhibitors or anti‐angiogenesis was the considerable treatment with considerable efficacy and safety for ES‐SCLC. Each treatment has a unique specific toxicity profile, which needs more attention.