Three competing paradigms define ES-SCLC combination therapy: (i) Immune-Maintenance, asserting that chemo-immunotherapy followed by ICI maintenance reaches an efficacy plateau (25); (ii) Early-Radiotherapy, proposing cycle-2 thoracic irradiation to ignite an immune-cold microenvironment (26); and (iii) Anti-Angiogenesis, advocating VEGF inhibition to remodel tumor vessels without excess myelotoxicity (27). The gene discussed is VEGFA; the disease is small cell lung carcinoma.