A concise and efficient asymmetric process for the total synthesis of (20S)‐7‐ethyl‐10‐hydroxycamptothecin (=SN‐38; 1f), an active metabolic form of the prodrug irinotecan, is described. This approach features the enantioselective cyanosilylation of indolizinone 4 into the corresponding cyanohydrin 5, mediated by a bifunctional thiourea‐based cinchona alkaloid under mild conditions, and I2‐catalyzed