Really the portability that matters in this case (games) is probably Windows, which llvm and clang do not target very well at this point.
also, even before that there were people using "non-standard" toochains e.g. http://en.wikipedia.org/wiki/Game_Oriented_Assembly_Lisp
And indeed it's possible to have an alternate toolchain, but lots of work that is best avoided most of the time.