The author of a comment article notes that substantial debate has surrounded the role of slow marker decline as an indicator of poor outcome after chemotherapy, and now this study has provided conclusive evidence that marker decline after the first treatment cycle can be used to detect patients with poor outcome and to identify those who are likely to benefit from early treatment intensification. She adds that although the study suggest changes to the management of patients with poor-prognosis germ-cell cancer, it leaves the important question about the optimum regimen unanswered, as the one used in the trial was complex and challenging and thus will probably not find many followers, not least because the study falls short of showing a significant overall survival benefit. Nevertheless, it represents another treatment option for such patients with unfavourable marker decline.