With the advent of cisplatin-based chemotherapy and the incorporation of adjunctive surgery, 70 to 80 per cent of patients with advanced germ cell tumors are cured. Serum tumor markers are important diagnostically and prognostically and are necessary for monitoring response to therapy. Patients with germ cell tumors may be divided into "good risk" (high likelihood of complete response) and "poor risk" (low likelihood of complete response) based on pretreatment serum tumor markers, extent of disease, histology, and primary site. For "good-risk" patients, new treatments are being investigated that maintain efficacy and ameliorate toxicity. For "poor-risk" patients, innovative therapy is needed to increase the proportion of complete responders. Further progress will be made only through careful randomized trials and the discovery of new drugs.