Forty-three patients with disseminated germ cell cancer were treated with a combination of vincristine, Adriamycin, cyclophosphamide, actinomycin-D, and medroxyprogesterone acetate. All the 43 patients were considered evaluable for response. Thirty-one patients (72%) achieved a complete or partial remission and 14 (32.5%) achieved a complete remission. The patients who attained an objective response obtained a significant prolongation of life compared with the nonresponders (median survival 55 vs. 23 weeks). Responses were seen in all histologic categories and most frequently in patients with metastases confined to the lungs. The major side effects were leukopenia and stomatitis. There were no deaths related to toxicity of the chemotherapy.