Poor-risk germ-cell tumors are defined by the presence of high serum tumor marker and large tumor burden. The standard treatment of this group of patients is four cycles of a combination of bleomycin, etoposide and cisplatin followed by the surgical exeresis of residual disease. Neither cisplatin dose-intensification nor alternating chemotherapy protocols, high-dose induction protocols and high-dose consolidation regimens have demonstrated better results than the standard chemotherapy regimen. The salvage treatment of germ-cell tumors is a combination of vinblastine, ifosfamide and cisplatin followed by the surgical exeresis of residual disease. The role of high-dose consolidation chemotherapy is studied in an international randomized trial. However high-dose chemotherapy is inactive in refractory disease patients. Innovative trials are developed in this group of patients.