Palliative treatment of germ cell cancer

•For the first time a definition of palliative is provided for germ-cell cancer patients. To our knowledge, this has never been attempted before.•We give a comprehensive review on treatment options.•We provide a clear algorithm for choosing palliative treatments.•We give expert advise on how to approach a patient before being declared palliative. Most patients with metastatic germ-cell cancer (GCC) can be cured by cisplatin-based combination chemotherapy. Yet, about 10–15% of metastatic GCC patients will eventually die of their disease. This narrative review focuses on treatment options when cure is no longer realistic.