Hoskins PJ, Le N, Kumar A, et al. - Since there is lack of consensus on the optimal chemotherapy for low risk gestational trophoblastic neoplasia, WHO prognostic score of 0 to 6, and the common regimens include q2wk actinomycin-D (ACT-D), weekly intramuscular methotrexate (MTX) or multi-day MTX, and, the combination MTX/ACT-D is rarely opted, so, researchers compared commonly used regimens: weekly MTX, q2weekly ACT-D and q2 weekly MTX and ACT-D, in this four centre, retrospective cohort analysis. This study involved 412 patients (196 MTX/ACT-D, 107 MTX, 109 ACT-D) who received treatment between October 1994 and January 2019. The occurrence of initial regimen failure (secondary to resistance or toxicity) was reported in 37% (MTX), 21% (ACT-D) and 5% (MTX/ACT-D). Rarely relapse occurred following the completion of primary therapy (initial plus switch to another therapy if required). All ultimately were cured. WHO prognostic scores of 5 to 6 and HCG levels ≥ 10,000 were associated with the occurrence of higher failure rates. With MTX, initial regimen failure (ie the requirement to switch to an alternative therapy) was more common. Within prognostic score 0–4 or HCG < 10,000, ACT-D and MTX/ACT-D were shown to be similar. Owing to its superior convenience, ACT-D then seemed the better initial option. Above these levels, less primary failure rates were reported with MTX/ACT-D, indicating that it is a better option.