Small-cell lung cancer (SCLC) is a particularly aggressive form of lung cancer characterized by early and widespread metastases and the ability to rapidly develop resistance against chemotherapeutic agents. Tumor cell migration and metastasis share many similarities with leukocyte trafficking, which is critically regulated by chemokine receptors and adhesion molecules. SCLC cells express high levels of CXCR4 (CD184), a seven-transmembrane G-protein-coupled chemokine receptor. Stromal cells within the bone marrow microenvironment and at extramedullary sites constitutively secrete stromal cell-derived factor-1 (CXCL12), the ligand for CXCR4. Activation of CXCR4 induces SCLC cell migration and adhesion to stromal cells that secrete CXCL12, which in turn provides growth- and drug resistance-signals to the tumor cells. CXCR4 antagonists, such as Plerixafor (AMD3100) and T140 analogues (TN14003/ BKT140), disrupt CXCR4-mediated SCLC cell-adhesion to stromal cells. In stromal cell co-cultures, CXCR4 antagonists also sensitize SCLC cells to cytotoxic drugs, such as etoposide, and thereby antagonize cell adhesion-mediated drug resistance. Therefore, targeting the CXCR4-CXCL12 axis is a novel, attractive therapeutic approach in SCLC. Here, we summarize preclinical data about CXCR4 in SCLC, and the current status of the preclinical and clinical development of CXCR4 antagonists.