My Mayo/Alimta experience has been different. They have always said "since you are tolerating the treatment so well" leaving me with the impression that if I wasn't they would be ready with an alternative. I do know the folic acid, B-12 and steroid supplements are for the side effects of Alimta and you have to be pretty disciplined with those.

That is a great question and one we were exploring for my husband but alas, the Alimpta (Chemo) and Keytruda (immunotherapy) didn't work over the 12 weeks and now we're on the path to discover which thing caused his Atrial Fibrilation of the heart (chemo? radiation? Keytruda?). It's an important question because his options are now just radiation and chemo (no immunotherapy), as it didn't work. Immunotherapy ramps up your own immune system to kill the cancer cells and it's a blessing to so many. In my husband's case, they really aren't sure and have never been sure what type of cancer he has. No biopsy showed the cancer type conclusively so they had to 'guess' it was lung finally when it spread to his bones. It might not react to the Keytruda because he didn't have much PDL1 in the biopsy tissue, which is what Keytruda needs to work. Instead of killing cancer, I guess the Keytruda got bored and decided to attack his heart.....which immunotherapy can do - attack your own organs, although that is rare. Hugs to all and glad to hear this protocol is working for some...that's good news. We're still on the path to figuring out what might help my husband.
Hugs