LB-100, Carboplatin, Etoposide, and Atezolizumab for the Treatment of Untreated Extensive-Stage Small Cell Lung Cancer

Inclusion Criteria:

* Histologically or cytologically confirmed extensive-stage disease small cell lung carcinoma per the Veterans Administration Lung Study Group (VALG) staging system
* Measurable disease as defined by Response Evaluation Criteria in Solid Tumors (RECIST): Revised RECIST guideline (version 1.1)
* Estimated life expectancy of at least 12 weeks
* For women: Must be surgically sterile (surgical procedure: bilateral tubal ligation), post-menopausal (at least 12 consecutive months of amenorrhea) or have a negative pregnancy test. Women of childbearing potential must be compliant with a medically approved contraceptive regimen (intrauterine device \[IUD\], birth control pills, or barrier device) during and for 3 months after the treatment period; must have a negative serum or urine pregnancy test within 14 days before study drug treatment and must not be breastfeeding
* For men: agreement to remain abstinent or use medically approved contraceptive measures, as defined below:

  * With female partners of childbearing potential or pregnant female partners, men must remain abstinent or use a condom during study therapy and for at least 6 months after the last dose of study therapy to avoid exposing the embryo
* A performance status of 0-2 on the Eastern Cooperative Oncology Group (ECOG) scale
* Absolute neutrophil (segmented and bands) count (ANC) \>= 1.5 x 10/L
* Platelets \>= 100 x 10/L
* Hemoglobin \>= 9 g/dL
* Bilirubin =\< 1.5 times upper limits of normal (ULN) may be enrolled
* Alkaline phosphatase (AP), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =\< 3.0 times ULN (AP, AST, and ALT =\< 5 times ULN are acceptable if the liver has tumor involvement)
* Calculated creatinine clearance (CrCl) \>= 60 mL/min based on the Cockcroft and Gault formula
* All subjects must have the ability to understand and the willingness to sign a written informed consent
* No prior systemic chemotherapy, immunotherapy, biological, hormonal, or investigational therapy for SCLC

Exclusion Criteria:

* Currently enrolled in, or discontinued within the last 30 days from, a clinical trial involving an investigational product or non-approved use of a drug or device, or concurrently enrolled in any other type of medical research judged not to be scientifically or medically compatible with this study
* Diagnosis of non-small cell lung cancer (NSCLC) or mixed NSCLC and small cell lung cancer (SCLC)
* No prior malignancy other than SCLC, carcinoma in situ of the cervix, or nonmelanoma skin cancer, unless that prior malignancy was diagnosed and definitively treated 5 or more years prior to study entry with no subsequent evidence of recurrence. Patients with a history of low grade (Gleason score =\< 6 = Gleason group 1) localized prostate cancer will be eligible even if diagnosed less than 5 years prior to study entry
* Serious concomitant systemic disorder that, in the opinion of the investigator, would compromise the patient's ability to adhere to the protocol
* Active or ongoing infection during screening requiring the use of systemic antibiotics
* Serious cardiac condition, such as myocardial infarction within 6 months, angina, or heart disease as defined by the New York Heart Association class III or IV
* Clinical evidence of central nervous system (CNS) metastases or leptomeningeal carcinomatosis, except for individuals who have previously-treated CNS metastases, are asymptomatic, and have had no requirement for steroid medication for 1 week prior to the first dose of study drug and have completed radiation 2 weeks prior to the first dose of study drug
* Known or suspected allergy to any agent given in association with this trial
* Pregnant or lactating women
* History of autoimmune disease, including minor/mild autoimmune disease not requiring immunosuppressants (such as eczema on less than 10% of the body surface area and long term diabetes mellitus type 1 on stable insulin)
* Known hepatitis B or hepatitis C
* Known human immunodeficiency virus (HIV) positive
* Treatment with systemic corticosteroid or other immunosuppressive medication. The use of inhaled corticosteroids for chronic obstructive pulmonary disease, mineralocorticoids (e.g., fludrocortisone) for patients with orthostatic hypotension, and low-dose supplemental corticosteroids for adrenocortical insufficiency are allowed
* Administration of a live, attenuated vaccine within 28 days prior to study
* Uncontrolled pleural effusion, pericardial effusion, or ascites requiring recurrent drainage procedures (once monthly or more frequently). Patients with indwelling catheters are allowed
* Uncontrolled or symptomatic hypercalcemia (\> 1.5 mmol/L ionized calcium or calcium \> 12 mg/dL or corrected serum calcium \> ULN). Patients who are receiving denosumab prior to study entry must be willing and eligible to discontinue its use and replace it with a bisphosphonate while in the study
* History of idiopathic pulmonary fibrosis, organizing pneumonia (e.g., bronchiolitis obliterans), drug-induced pneumonitis, idiopathic pneumonitis, or evidence of active pneumonitis on screening chest computed tomography (CT) scan. History of radiation pneumonitis in the radiation field (fibrosis) is permitted
* Prior allogeneic bone marrow transplantation or solid organ transplant
* QTcF (Fridericia Correction Formula) \> 470 on 2 out of 3 electrocardiograms (EKG's)
* Diagnosis of congenital long QT syndrome
* Treatment, within 7 days prior to first dose of study drug, with medications that are known to prolong the QT interval and/or are associated with a risk of torsades de pointes
* Treatment with CYP450 substrates within 7 days prior to first dose of study drug
* Treatment with nephrotoxic compounds within 7 days prior to first dose of study drug
* Treatment with warfarin within 7 days prior to first dose of study drug
* Treatment with antiepileptic medications that may increase etoposide clearance (including but not limited to phenytoin, phenobarbital, carbamazepine, and valproic acid) within 7 days prior to first dose of study drug
* Treatment with strong P-glycoprotein inhibitors within 7 days prior to first dose of study drug
* Subjects, who in the opinion of the investigator, may not be able to comply with the safety monitoring requirements of the study